Dupuytren’s contracture

What is Dupuytren’s disease?

Dupuytren’s disease is a condition that causes changes in your hand and fingers. It starts when connective tissue in the palm thickens and noticeable lumps or ‘nodules’ form beneath the skin. They may become cords that run along the fingers. When they contract, they pull fingers towards the palm.

Could your hands be showing signs of underlying health conditions?

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What are the symptoms of Dupuytren's disease?

Nodules usually appear in the palm, around the area where a crease forms when you bend your fingers. They may sometimes be found lower down the hand, or in the fingers themselves. The nodules can be up to one centimetre across, but are usually painless – or only painful for a short while after they appear.

Small pits may also appear in the hand, close to the lumps, or on their own.

Tissue cords may then develop in the hand. These hard, rope-like structures just under or in the skin run along the finger tendons to the base of the palm or just stay in the finger. They tend to appear to grow from nodules, though they may not seem to be linked to any obvious lump at all.

Common skin conditions in the over-50s

How does Dupuytren’s disease affect you?

Though not everyone who has a lump or cord will have further problems, after a few months or even years, many will experience contracture. This occurs when the tissue cords start to contract, drawing your fingers towards your palm. This can make it difficult to do anything from threading a needle to shaking hands with someone. If untreated, your fingers can become permanently bent.

If you detect any Dupuytren’s disease symptoms, visit your GP, who may refer you to a hand surgeon or specialist.

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What are the causes of Dupuytren’s disease?

The reasons why Dupuytren’s disease develops aren’t clear. Many experts believe genetics is the major factor. As many as two third of people with the condition have some family history of it.

North Europeans are particularly affected and the condition is also known as Viking’s disease, because of the belief that it has its genetic roots in the Scandinavian invaders.

Various other factors have been put forward as explanations, but the research is inconclusive. These include:

• epilepsy medications
• anticonvulsants
• heavy drinking
• smoking
• diabetes

The condition has been said to be common in people who used their hands a lot in their career or hobbies, such as manual labourers or cricketers. But, again, no firm link has been established.

Dupuytren’s disease is generally more common in older people, particularly men aged 50+. More than one in ten Britons have the condition at 55 and almost a third at 75.

What are the treatment for Dupuytren’s contracture?

Radiation therapy

Used before the fingers contract. Rays are aimed at the lump in your hand to stop the production of collagen.

Collagenase clostridium histolyticum

Medicine used in less severe cases. It’s injected into the hand to weaken the collagen cord, which may then break. Side effects can include swelling, itching or dizziness.

Needle fasciotomy

A surgeon pushes a needle or blade into your skin to divide the cord and release tension. Good for those unable to have extensive surgery. But around 60% of patients feel the contracture return within three to five years.

Open fasciotomy

In slightly more serious cases, the hand is opened up to allow for cutting more of the cord.

Fasciectomy

Procedures carried out under general or regional aesthetic. For patients with more severe problems.

Regional and segmental fasciectomy: connective tissue is removed, rather than cut, via a large incision or several smaller ones.

Dermo-fasciectomy: the tissue and its overlying skin is removed and replaced by skin grafted from another part of the body.

Nerve damage and infection occur in around one in 20 cases, and some 8% of fasciectomy patients are believed to experience Dupuytren’s contracture again.

For information on the disease and sources of help, visit www.thisisdupuytrens.com.

Read our great interview with cricket commentator Jonathan Agnew about his experiences of having Dupuytren’s contracture in the August issue of Saga Magazine.

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