Dupuytren's Disease
A cord may form and eventually cause the finger to flex down towards the palm.
A cord may form and eventually cause the finger to flex down towards the palm.
Description
Dupuytren's disease is an abnormal thickening of the layer of tissue just below the skin of the palm and fingers. Disease progression can lead to contractures of the fingers causing the inability to fully open the fingers. There are many causative factors for Dupuytren's disease, with one of the largest being genetics. Patients who are of Eastern or Northern European descent are most commonly affected. Dupuytren's disease can also occur after minor trauma, surgery, and sometimes for no definable reason at all.
Patients with a history of Diabetes, seizures, smoking, or Dupuytren's-like diseases in other parts of the body are at increased risk for getting Dupuytren's disease. Theoretically, patients with a known history of producing extra scar tissue or keloids may also have an increased risk.
Symptoms
Symptoms of Dupuytren's disease usually include firm lumps, nodules, pits, and even cords under the skin of the palm and fingers. The nodules can be painful and tender, especially during the initial phases of the disorder. This pain usually resolves over time. If cords develop, they may eventually cause the fingers to contract towards the palm.
Diagnostic Testing
Dr. Steven Lee will typically diagnose your Dupuytren's disease clinically. However, an x-ray and other radiologic studies may be obtained if the diagnosis is in question or to rule out other disorders.
Treatment Options
Dr. Steven Lee employs many treatment options to treat your Dupuytren's depending on the severity of the disease and the patient's symptomatic and functional disability. Many studies have shown that Physical/Hand therapy does not actually improve upon the progression of the disease, so this is usually not prescribed.
Patients with painful nodules can be treated with cortisone injections, which can help lessen the pain as well as soften the nodules. Different types of injections have been developed to help treat the cord causing the contracted finger as well. Collagenase injections (Xiaflex) has shown good success in helping to rupture the cord and increase the range of motion. However, there are some significant catastrophic side effects that occur with its use such as tendon ruptures, and the recurrence rates after their use have been reported to be higher than some other recommended forms of treatment.
Percutaneous Needle Fasciotomy release of the cord using a needle has also been shown to successfully rupture the cord. Again, there are side effects associated with this as well, including accidental damage nerves and tendons. However, given the right patient and conditions, both Collagenase and Percutaneous Needle Fasciotomy can be successfully used to treat your Dupuytren's without formal surgery. Dr. Steven Lee can go over these treatment options to see if they are right for you.
Surgical Treatment
Formal surgery is still considered the gold standard treatment for those patients who's contractures have exceeded certain angles or the hand is no longer able to placed flat on a table. This is especially true in those that have not improved from non-operative means. Here too there are multiple options depending on a number of confounding factors. The surgery can be performed in a minimally invasive manner. This consists of making an incision less than an inch long and cutting the cord under direct visualization, thereby minimizing potential damage to the nerves or tendons. Some patients with very extensive disease may require a much larger incision in order to be adequately released. Skin grafts are sometimes even required in the most severe or recurrent forms of the disease.
Surgery for Dupuytren's disease, especially for those with severe contracture, will test any hand surgeon. Surgical skill is paramount for the treatment of this disease, and some hand surgeons actually shy away from performing this surgery because of this. Dr. Steven Lee has over 20 years of experience in successfully treating this disorder. He considers this surgery one that he performs as good or better than anyone in the country. He is regularly referred patients to treat the most aggressive forms of this disease as well as to treat revision surgeries.
Recurrence after surgery or injection-based treatments is a known possibility, and can be as much as 50%, which typically occur many years after the treatment. If it recurs to a point again where treatment is necessary, revision treatments such as Percutaneous Needle Fasciotomy, Collagenase, or repeat surgery can be performed.
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Recovery Expectations
Post-operative care depends on which type of treatment was utilized. If formal surgery was performed, it is important for the patient to adhere to the post-operative instructions such as elevating the hand and keeping the dressing clean and dry. Splints may be used depending on the severity of the disease and treatment type utilized. Sutures that were put in are often left in place longer than other surgeries (around 2 weeks). No matter which treatment is rendered, early range of motion and hand therapy (OT) is typically advised. OT can go on for several months.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City and Scarsdale.