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The disease was named after Baron Guillaume Dupuytren, a French surgeon who first described the disease in 1831. A not uncommon condition, Dupuytren's disease is a thickening of the fascia--the tissue under the palm's skin. This thickening can cause the fingers--usually the little and ring fingers--to bend into the palm and can prevent the fingers from being straightened. It is usually progressive, causing more deformity over time.
The exact cause of Dupuytren's disease is unknown, but in some cases, it runs in families. Dupuytren's usually occurs in Caucasians with ancestors from Northern Europe, and more often in men than in women. Generally, it starts after the age of 40, unless one has a strong hereditary predisposition or a childhood seizure disorder. Dupuytren's disease can occur in association with the long-term use of anti-seizure medication.
Dupuytren's disease isn't painful. In its early and/or less severe stages, Dupuytren's disease may manifest as only small, occasionally tender lumps in the palm, most often at the base of the ring or little finger. There may also be one or more dermal pits--small indentations of the skin on the palm. As Dupuytren's disease worsens, a thick band may develop from the palm to the fingers and gradually draw the fingers toward the hand. A patient may notice an inability to place the affected palm flat on a table. If the disease becomes severe, patients may be unable to put their hands into gloves or pockets, or have difficulty with daily activities which require the use of the affected hand.
The physician will usually be able make to make a diagnosis simply by taking the patient's history and noting one or more of the above findings on examination.
There is no cure for Dupuytren's disease, but the finger deformity can usually be treated. Mild deformities--just lumps or dermal pits on the palm with no deformity of the fingers--may be treated with periodic observation. When the finger or fingers start to bend and cannot extend fully, surgery is usually recommended because progressive loss of hand function usually ensues and permanent joint stiffness can occur. While surgery can often dramatically improve the fingers, it may not be a permanent cure as the problem may recur in the future.
For Dupuytren's disease surgery, the thickened fascia and cords (not the tendons) are removed from the palm and affected fingers--usually under regional anesthesia. Following the surgery, the hands is wrapped in a bulky dressing for a few days. The wounds may be slow to heal, and will be monitored closely by the hand surgeon. A program of occupational therapy will be instituted, and may be necessary for several months to regain full finger mobility. Splinting the affected fingers--usually at night--may also be necessary for several months.
