Dupuytren's disease, also known as Dupuytren's contracture, is a hand deformity. It affects a thick layer of tissue that lies under the skin of the palm. Over a period of years, nodules, bands, and cords of tissue gradually form under the skin. These thick cords can pull one of more fingers into a flexed position so that the fingers cannot be straightened, ultimately getting in the way of normal hand function. This affects many everyday activities - such as holding a tray or putting the hand in a pocket. Dupuytren’s disease most often affects the ring finger and other small fingers and may occur in one or both hands.
The cause of Dupuytren's disease is unknown, but it is most likely to affect older men of Northern European descent. The contracture typically begins to develop after age 50, and men who have Dupuytren's disease usually have more severe contractures than women with the condition. There may be a genetic component, as Dupuytren's disease tends to run in families. Smoking and alcohol use increase the risk of Dupuytren's disease and people with diabetes are more likely to develop the condition.
The goal of Dupuytren’s disease treatment is to remove or release the tight, diseased cords of tissue that cause the contracture. Physical therapy and stretches have not proven to be helpful and have not been shown to slow the progression of the contractures. There are several successful treatment options, which include needling or needle aponeurotomy which involves puncturing the skin to break the tissue cord. This method has a high incidence of recurrence but alleviates the problem temporarily. Injections of an enzyme called Collagenase may soften and weaken the cord, allowing the doctor to stretch the finger out. This is controversial with a high incidence of recurrence and is indicated in certain anatomic areas and clinical situations. Surgery is often recommended for contractors that are causing significant functional problems. The surgeon will go in and remove the tight band of tissue and may need to rearrange the skin to allow release by specialized incisions called Z-Plasty, and occasionally in very severe cases skin grafting may be needed. Surgery is done as an outpatient procedure and takes about an hour. Hand therapy is recommended post-operatively.
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