Dupuytren’s Disease

Mr Mike Hayton
FRCS(Trauma and Orth) FFSEM (UK)
Consultant Orthopaedic Hand Surgeon

Other common names

None

Who does it affect?

Usually males over the age of 40 years, occasionally females.

Why does it occur?

There are a number of risk factors associated with developing Dupuytren's disease. These include amongst others: genetic (inherited), diabetes, excess alcohol intake, epilepsy and/or its treatment. In the vast majority of patients we do not know why they develop the disease, but is probably inherited to some extent.

Symptoms

Thickening and cord like structures develop gradually in the palm and extend into the fingers causing the fingers to roll up into the palm. In the initial stages the nodules can be tender but this usually settles.

Clinical Examination

The disease is usually very easy to diagnose and has a very characteristic appearance. A simple test to try and evaluate the severity of the disease is the "table top test". The patient is asked to place the hand flat on the table. If they are unable to do so then it is likely that disease may need surgery in the future.

Investigations

None

Non-operative treatment

Occasionally night splinting by a therapist will allow the fingers to straighten. However these are not well-tolerated long term.

Operative treatment

The surgery is usually as a day case procedure usually under general anaesthetic and takes between 30 and 60 minutes. A tourniquet is used; which is like a blood pressure cuff around the upper arm that prevents blood from obscuring the surgeons view.

The surgery is performed through a zigzag type incision in the palm and along the finger. The skin flaps are elevated and great care is taken not to injure nerves and blood vessels to the finger. The Dupuytren's disease removed. Occasionally in more advanced cases a skin graft needs to be placed over the wound. The skin is taken from the forearm (my choice) or groin (for larger grafts). The tourniquet is then released and any bleeding controlled. Local anaesthetic is infiltrated into the skin. The skin is sutured and a bulky dressing is applied with a Plaster of Paris slab for immobilisation

Post-operative rehabilitation

The anaesthetic will wear off after approximately 6 hours. Simple analgesia usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. My preference is to remove the dressing between 2 and 3 days. The wound is cleaned and redressed with a simple dressing. The skin stitches are removed between 10 and 14 days post op. The therapist will apply a resting night-time splint that should be used at night for 6 months.

 Click here to download a pdf on post operative instructions

Return to activities of daily living

It is my advice to keep the wound dry until the stitches are out at 10 days.

Return to driving:

The hand needs to have full control of the steering wheel and left hand the gear stick. It is probable advisable to delay returning to driving for at least 10 days or even once the sutures are removed.

Return to work:

Everyone has different work environments.
Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Please ask your surgeon for advice on this.

Complications

Overall greater than 95% are happy with the result. However complications can occur.
There are complications specific to Dupuytren's surgery and also general complications associated with hand surgery.

General complications:

 - Infection (Less than 1%)
 - Neuroma (Less than 1%, a coiled painful nerve bundle)
 - Numbness

Reflex Sympathetic Dystrophy - RSD (2% bad reaction to surgery with painful stiff hands- this can occur with any hand surgery from a minor procedure to a complex reconstruction.)

Specific complications:

Recurrence: the disease will always recur, however, most patients have a long lasting result that they are happy with.
Failure to completely straighten the finger (particularly after the 2ndand 3rd time surgery or advanced disease).
Injury to the blood vessels and nerves to the finger (very much less than 1%) may leave one side of the finger numb. If this occurs the wound should be explored and if injured, the nerve repaired.
The skin graft, if used, not healing.