Dupuytren’s Disease

With Dupuytren’s ("duh-pwee-TRAHNZ") disease, tissue under the skin in the palm of your hand, called the palmar fascia, gets thicker and shorter. This can cause your fingers to bend in toward your palm. It most often affects the ring and small fingers, usually on both hands. It also can affect the soles of the feet. 

The disease may involve only the palm and never affect your fingers. If it gets worse, it may be hard to use your hands. Dupuytren’s disease is also called Viking’s disease.

The cause of Dupuytren’s disease isn’t known, but your risk of having it is increased if you:

• Have relatives who have the disease
• Are of northern European heritage
• Are male
• Are older than 50
• Have diabetes or alcohol use disorder
• Smoke

Dupuytren’s disease has three general phases:

• In the early phase, you may see or feel a small lump in the palm of your hand, usually near where your ring finger and small finger meet.
• In the active phase, you may have dimpling on the skin of your palm. Long, ropy cords or bands form in the fascia. You may be able to see or feel them.
• In the advanced phase, a fibrous cord may form in the fascia that pulls your fingers toward your palm. This is called Dupuytren’s contracture. Over time, you won’t be able to straighten your fingers or flatten your hand on a table. It may be hard or impossible to do things like put on gloves, wash your hands or pick things up.

In most cases, Dupuytren’s disease doesn’t cause pain. You may not even notice it until you develop a contracture. The disease usually gets worse slowly. In many people, it never causes major problems.

A physical exam and medical history will usually provide enough information for a doctor to decide if you have Dupuytren’s disease. Your doctor will:

• Look for skin changes on your palm and feel for any knots or a cord
• Watch you move your hand, wrist and fingers
• Ask questions about your family medical history, symptoms, other medical conditions and history of tobacco and alcohol use

The goal of treatment for Dupuytren’s disease is to keep your hand working as well as possible. You may not need treatment unless you have a contracture. Treatment options include:

• Collagenase injection: A medicine called collagenase (such as Xiaflex) may be injected into the tight cord to try to dissolve some of the tissue. This may help reduce the contracture and improve your range of motion.
• Needle aponeurotomy ("ap-uh-noo-RAH-tuh-mee"): A needle is used to make small holes in the tight cords in the palm. The fingers are then extended to separate the cords.
• Surgery: The affected tissue in the palm is removed or separated.
• Fasciectomy ("fash-ee-ECK-tuh-mee"): Used most often to correct a contracture, the thick tissue under the skin of the palm is surgically removed. A skin graft may be done to cover open areas in the palm. After surgery, you will need to follow a program of hand exercises and massage to help you move your fingers again.

Your hand may work better after surgery, but you may not get back the full use of your hand. Even when surgery is successful, Dupuytren’s disease comes back about half the time. So you might need another surgery later.

If your symptoms are mild, you can try gentle stretching exercises and massage. There isn’t much evidence that they reduce symptoms or slow the disease, but they are easy to do, and they may help keep your hand flexible. 

You can also try to avoid curling your hand tightly. For example, you can use utensils and tools that have larger hand grips.