Dupuytren’s disease

Dupuytren’s disease

Dupuytren’s disease is a common hereditary disorder (approximately 3 to 5% of the European population) that manifests itself as nodules or flanges on the palms or fingers.

This is a localized thickening of the superficial palmar fascia.

Dupuytren’s disease appears spontaneously and is often progressive.

It can take several forms:

• nodules, cords or bridles
• wells.

As a rule, Dupuytren’s disease lesions are always painless. They lead to progressive and permanent limitation of finger extension. The speed of evolution is unpredictable.

The fingers most frequently affected are the ring finger, then the little finger and finally the middle finger. Functional impairment progressively appears in simple daily activities. Treatment may become necessary when it becomes difficult to put the hand in the pocket or flat on a table.

What additional tests are needed to diagnose Dupuytren’s disease?

No further examination is necessary, as the diagnosis is clinical.

How is Dupuytren’s disease treated?

Non-surgical treatment :

To date, no non-invasive treatment (medication, occupational therapy, acupuncture) has been shown to be effective for Dupuytren’s disease. An injectable product for the disease had been in use for several years, but was recently discontinued in Switzerland. There is no preventive treatment for Dupuytren’s disease.

Surgical treatment :

• Aponevrotomy

This is a minimally invasive, outpatient treatment that involves cutting the taut cord bringing the finger back into flexion. This can be done during the consultation with our surgeon, under local anaesthetic using a needle. The aim is to weaken the rope and then break it by putting it under tension. The same procedure can be performed in the operating room, using a scalpel.

A bandage is worn for two or three days, and a return to light work can be envisaged after a few days.

• Aponectomy

This is an operation during which an incision is made on the rope to remove it.

This operation is performed in the operating room of the Clinique de la main in Geneva under locoregional anaesthesia(only the arm is asleep), using an inflatable tourniquet.

The aim is to remove the cords/bridles through more or less extensive incisions, depending on the stage of Dupuytren’s disease. Sometimes, the skin is infiltrated by the disease and has to be removed. There are several ways to replace it: either by letting it heal spontaneously, or by transplanting skin (skin flap or graft).

At the end of the procedure, the hand is immobilized in a thick bandage, and sometimes a cast is applied for a few days. The bandage is redone after two to three days and lightened so that the fingers can move.

A night splint of the “palette” type, immobilizing one or more fingers in a straight position, can be used for up to three months. Occupational therapy sessions are also available to help loosen the fingers. Time off work varies from one to six weeks, depending on the profession and the extent of the operation. Sports activities requiring the use of the operated hand should be avoided for one month.

What are the possible complications?

• Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.
• Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small. When it is larger, surgical evacuation may be necessary.
• Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.
• In very rare cases, an involuntary injury to an artery, nerve, ligament or tendon may occur… These structures can be repaired, but recovery will be prolonged and may be incomplete.
• Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

What are the possible complications of Dupuytren’s disease?

• Cutaneous necrosis (part of the skin that does not survive and forms a black crust) may occur, particularly in smokers. If only a small area is affected, healing will occur spontaneously. If the necrosis is more extensive, a new operation may be proposed.
• Recurrence is not uncommon, affecting 30% of patients. When this leads to further disability, further surgery may be proposed.
• A lack of extension of the operated finger(s) may persist, especially in advanced forms of the disease.