DUPUYTREN'S DISEASE AND CONTRACTURES OF THE PALM AND FINGERS
Palmar fascia is a layer of fibrous tissue beneath the skin of the palm and fingers. Fascial attachment to both the skin and underlying bone helps prevent slippage of the skin when an object is grasped. Dupuytren's disease is an abnormal thickening of the palmar fascia. The contracture of the diseased fascia, which forms a band, cord or pit, is known as Dupuytren's contracture.
WHO IS DUPUYTREN?
Guillaume Dupuytren, a French surgeon, clarified the nature of this disease in 1831. His classic dissections and teachings led to the adoption of his name to identify the condition.
WHO GETS THE DISEASE?
It mostly affects white persons of North European ancestry. This explains the high incidence in Australia, Canada and the USA. Males outnumber females 8:l, and women usually have a milder form of the disease. It is slightly more frequent in non-laborers, and often occurs in both hands. Heredity is a major factor and the disease may affect successive generations. Although prevalent in the 40-60 age group, the most aggressive form is in younger males. The youngest reported case was an 11 year old female. Her father had severe bilateral disease.
WHAT CAUSES DUPUYTREN'S?
Despite the detailed knowledge about the disease, research has not established the cause. Clinical studies confirm a higher incidence in alcoholics, diabetics and persons with epilepsy. There is no proof that injury can cause Dupuytren's. However, patients with a predilection for the disease may have an earlier onset as the result of an injury.
WHAT ARE THE SIGNS AND SYMPTOMS?
Dupuytren's usually begins as a painless lump or pit near the palmar crease at the base of the ring, little or middle fingers, or along the front of a finger. The index finger and thumb are seldom involved.
A contracting band or cord of diseased fascia may take years to form. When a joint is crossed, joint straightening is limited and the hand cannot lay completely flat. The skin and ligaments shorten secondarily, and knuckle pads of thickened skin occasionally form over the middle joint of the fingers. As the fingers are drawn painlessly into the palm daily activities such as shaking hands, washing, putting on gloves, or entering a pocket become clumsy.
There may be ligament tightness in other areas of the body such as the shoulder, and rarely the fascia on the sole of the foot may be thickened. Penile scarring has also been described.
HOW IS IT TREATED?
This is a surgical disease. Splints, steroid injection, x-ray and aggressive hand therapy are of no help in the control or reversal of the contracture process. Normal function can be restored only by removing the diseased fascia, releasing the tight ligaments, and lengthening the contracted skin. Painless lumps and knuckled pads seldom require treatment.
WHAT ARE THE RESULTS?
The disease is not curable, but good function can usually be restored. The best results are obtained with early treatment, particularly when the fingers are contracted. Only the diseased tissue is removed, hence other parts of the fascia may be involved later. Although it is rarely necessary to reoperate in the same areas of the palm, recurrence is seen in the fingers. Secondary surgery is more difficult and the return of full motion is less certain when contractures are long standing.
THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.
THE CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
1211 Johnson Ferry Rd
Marietta, GA 30068