A Brief Overview of Dupuytren’s Disease

We take for granted our body’s ability to heal itself by laying down scar tissue.  When we have a paper cut, we can simply clean the wound and a week later, there is little evidence of the original injury, as our body creates and lays down connective tissue to close the wound.  But when there is a disruption in this normal healing process, fibrotic tissue may form, which is tough scarring and is difficult to reverse.  Dupuytren’s disease is common diagnosis that involves this abnormal formation of fibrotic tissue and although considered a systemic process, most commonly this fibrotic process is seen in the palms of the hands.

These fibrotic changes can range from mild, without any limitation, to severe, where hand function is noticeably affected.  Initially, nodules form in the palm.  Band and cords then may form in the hand, causing of the first two joints in the digits (metacarpal phalangeal-MP-and proximal interphalangeal-PIP- joints) to bend inward.  This bending is known as a flexion contracture and in Dupuytren’s disease, is most often observed in the ring and small fingers.   Passive stretching and pre-surgical splinting alone have been shown to not have significant effect on improving these contractures and therefore, hand function.  Once the hand becomes limited with daily life, evaluation by a hand surgeon is necessary.

There are several interventions available and the hand surgeon chooses the appropriate treatment depending on severity of contractures, location of contractures as well as other considerations, such as other co-morbid diseases.  Open fasciotomy has been the standard treatment for Dupuytren’s contractures but it is also the most aggressive.  The surgeon opens the palm and/or digit and uses a scalpel to physically release the cords causing the deformity.  In a closed aponeurotomy, the surgeon uses a needle to manipulate and weaken the cord.  Although there is less complication and an expedited recovery with the needle aponeurotomy, studies show the contracture recurrence after one year is twice as high (10-20% compared to 5-10%), with the PIP joint most affected.  Collagenase, an injected enzyme which breaks down palmar collagen, is showing promise as an alternative to these two previous interventions, but since it’s new to the market, more research is needed.   Following each of these procedures, the surgeon may elect for splinting, where a skilled hand therapist fabricates a custom orthosis to maintain the released joints straight post-operatively and may recommend nighttime splinting for several months.  It is also common to have limited ability to fully grasp and form a fist following these procedures, and a formal exercise program established by a hand therapist can also help regain motion.

Dupuytren’s contracturers. Note the person on the left is experiencing increased contractures at the ring finger MP joints. Image from the Dupuytren’s Foundation.

Although millions of people are living with Dupuytren’s disease worldwide, there is no prevention or cure available.  Because Dupuytren’s is a disruption in the scarring process and is considered a systemic disease, any intervention that limits the formation of scarring with Dupuytren’s will ostensibly affect the entire body’s ability to heal.  At this time no biomarker has been found, meaning a simple blood test cannot indicate current or future Dupuytren’s contractures; instead, physical changes are the primary means of diagnosing.  The Dupuytren’s Foundation’s website provides insight to current research and limitations.

1. Moorhart, M (2015). Pearls and pitfalls of needle aponeurotomy in Dupuytren’s disease. Plastic Reconstructive Surgery. March 153(D): 817-825.
2. (No author) (2013). Needle or open fasciotomy for Dupuytren’s contracture: A review of the comparative efficacy, safety, and cost-efffectivness-An Update. Canadian Agency for Drugs and Technologies in Health.

Additional information obtained from the Dupuytren’s Foundation website.

If you have Dupuytren’s Disease or think you might, schedule a complimentary injury screen with one our hand therapists today.