Dupuytren's contracture

Dupuytren's disease is a common but little-known condition that affects the hands of up to 2 million people in the UK.

The condition affects a layer of tissue (fascia) that lies under the skin of your palm. Knots/lumps of tissue start to form under the skin and these can eventually create a thick cord that can pull one or more fingers into a bent position.

It normally starts in just one hand but about 80% of sufferers will eventually have symptoms in both hands.

Why do people develop Dupuytren’s?

We’re not completely sure what causes Dupuytren’s, but it has been linked to risk factors including:

• Age (Dupuytren’s contracture occurs most commonly after 50)
• Having a family history of the condition
• Gender (men are more likely to develop the condition and to have more severe contractures)
• Smoking
• Ancestry (people of Northern European descent are at higher risk)
• Excessive alcohol consumption
• Diabetes
• Epilepsy

What are the symptoms of Dupuytren’s?

A Dupuytren's contracture usually progresses slowly over several years. The fists sign is typically a thickening or bunching of the skin (nodule) on the palm of your hand. This nodule is normally pain free but can be sensitive to pressure.

In more extreme cases or later stages of Dupuytren's, stronger bands of fascia (cords) can form in the palm and extend into the fingers. If these cords tighten over time it can cause the fingers to be pulled toward your palm so that you can’t straighten or extend them in the usual way.

When this happens, it’s called Dupuytren’s contracture.

Dupuytren’s tends to develop slowly and you might not need treatment at first. You should speak to your GP if one or more of your fingers is bent, you can’t put your hand down flat and it’s affecting your daily life.

Who is likely to develop Dupuytren’s?

Dupuytren’s tends to start aged 50-60 in both men and women. It is seen mainly in Caucasians. Dupuytren's is often inherited but can skip one or two generations and can also occur in people with no family history of the condition.

There is some suggestion that the disease was spread by the Vikings, hence the nickname 'the Viking disease'. Iceland has a very high prevalence of Dupuytren's disease, and it is well known by Scottish bagpipers as 'McCrimmons curse'.

However, recent genetic testing has disputed the Viking idea. Dupuytren’s has also been found in an Egyptian mummy, suggesting the gene(s) have been around a lot longer.

Some famous sufferers include Margaret Thatcher, Bill Nighy, David McCallum, Jonathan Agnew, Ronald Reagan, and pianist Misha Dichter. It affects people from all walks of life, but it has been recognised as an industrial disease for people who have worked for a long time with vibrating machinery.

Why is it called Dupuytren’s?

Dupuytren’s disease is named after Baron Guillaume Dupuytren, who in 1831 became the first person to perform an operation on a hand with Dupuytren’s contracture.

He is considered to be one of the greatest French surgeons in history and was also famous for treating Napoleon Bonaparte’s haemorrhoids.

How do I know if I have Dupuytren’s disease?

Dupuytren's usually starts with a nodule in the palm, though some people get nodules in the fingers, and in some people 'pitting' of the skin in the palm can be the first sign. This stage is not usually painful but can be at times.

There are other conditions that can cause these symptoms, and you can ask your GP if you are worried.

In most cases, the nodule will slowly develop a tight band of tissue known as a cord, which draws your finger(s) down towards your palm. The ring and little fingers are most commonly affected but it can happen with any of your digits. The cords may become so tight that you can’t extend your fingers, even using your other hand.

At this stage you’ll start to find everyday tasks more and more difficult and you should definitely speak to a doctor.

How does Dupuytren’s contracture affect everyday life?

At the British Dupuytren’s Society, we asked members of our Facebook community to tell us the things they found most difficult to do because of Dupuytren’s contracture.

The top 10 responses were:

1. Opening jars, bottles and other food containers
2. Using a car gear stick (and driving in general)
3. Pushing or pulling a trolley, pram, wheelbarrow or luggage
4. Clapping
5. Shaking hands
6. Using thin kitchen tools such as a grater or zester
7. Holding a toothbrush, hairbrush, or hair dryer; flossing
8. Exercising with weights or elastic cords; yoga
9. Raking leaves, gardening or shovelling snow
10. Using door handles or a handrail

What treatments are available for Dupuytren’s contracture?

Treatment for Dupuytren’s depends on the stage of the disease. In the early stages, where the nodules are forming and growing and there is no contracture, the condition is just monitored. It is best to 'watch and wait' to see if it progresses or just stays as is.

If the disease is more developed, a specialist hand surgeon will advise you on the best treatment option for you. There are three main treatments for Dupuytren’s contracture:

Surgery

This procedure is called a fasciotomy. Your surgeon will operate on your hand to remove the diseased tissue, allowing the finger(s) to straighten again.

This is the procedure with the lowest recurrence rate, but it requires a more intense period of rehabilitation than other methods. You will probably need a course of therapy with a hand therapist to help you get movement back, help you manage your scars and provide you with a hand splint you will wear at night.

Injections

A medicine called collagenase clostridium histolyticum is injected into your hand to loosen your finger(s). A few days later, the surgeon will straighten the finger(s).

This is done under local anaesthetic, you don’t need to stay overnight in hospital, and you should recover within two weeks.

However, your contracture is more likely to return to return after Dupuytren’s injections than if you had surgery.

Needling

This is where a needle is inserted into various points on your finger(s) and palm in order to loosen and straighten your finger(s). It’s called a needle fasciotomy.

The procedure is done using local anaesthetic and you’ll leave hospital the same day. Recovery takes about two weeks.

It’s often recommended for the early stages of contracture. However, your contracture is more likely to come back than if you have surgery.