Mr Andrew Mahon, Consultant Orthopaedic & Hand Surgeon

The Joint Clinic, Droitwich Spa

Dupuytren’s disease (also known as Dupuytren’s contracture) is a common condition in the United Kingdom.

Initially, firm lumps or nodules form just under the skin in the palm of the hand. Later, tight bands of tissue known as cords form in the palm of the hand and fingers and can ultimately cause the fingers to bend in towards the palm. There may also be small pits in the skin. The ring finger is usually affected first.

In some people, multiple fingers and even the thumb can be affected. The fingers slowly become increasingly bent over a period of months or years. The inability to straighten the fingers leads to difficulties with everyday activities. Some have difficulty in putting their hands into their pockets or gloves.

Despite a considerable amount of research, the cause of this condition is still unclear. It is more common in people of Northern European origin and tends to run in families. Recent research has identified a number of genes that seem to be linked to the condition. Some believe it was brought to the UK when the Vikings invaded. Dupuytren’s disease has also been linked to diabetes, smoking and high alcohol consumption but many sufferers have none of these risk factors.

Unfortunately the condition has no cure. In the early stages no treatment is required but, when the fingers are contracted enough to cause problems with function, some form surgery has been the only treatment until recently.

There are a number surgical treatment options depending on the severity of the contracture and, of course, the wishes of the person affected by the contracture.

Fasciotomy involves simply cutting the cord and is performed under local anaesthetic.

Segmental Fasciectomy involves removing a section of the cord or cords using a small incision or incisions and can be performed under local anaesthetic.

Fasciectomy (also known as selective fasciectomy or regional fasciectomy) involves removing the entire cord which is causing the finger to bend. This is the most common procedure.

Dermofasciectomy involves removing the cord which is causing contracture and the overlying skin. The skin is usually replaced with a skin graft. This procedure is usually reserved for people in whom the problem has recurred following previous surgery or young people with a severe form of Dupuytren’s disease.

Unfortunately Dupuytren’s disease can recur (return) in a finger which has undergone surgery or in other fingers.

A New Treatment

The latest treatment for Dupuytren’s disease involves injections rather than surgery and can be performed in an outpatient clinic. A very small number of hand surgeons have been performing this procedure in the UK over recent years. The treatment has been developed over the last 20 years in the USA and research has shown that the success rate is similar to that of surgery.

Currently, not all cases of Dupuytren’s disease are suitable for injection treatment but, for those in whom it is suitable, it appears to be a good alternative to surgery with a shorter recovery period. Whether or not it will revolutionise the treatment of this condition remains to be seen.

This treatment can currently only be administered by a Hand Surgeon who has undergone appropriate training and is not widely available yet. It is expected that this treatment will be available in Worcestershire in the near future.

Getting the Right Treatment

People suffering from Dupuytren’s disease who find their fingers are losing the ability to straighten their fingers should contact the GP. The best person to advise on the most appropriate treatment is a Hand Surgeon with experience in treating this condition.

About the author

Mr Andrew Mahon is a Consultant Orthopaedic & Hand Surgeon based at The Joint Clinic and the Alexandra Hospital, Redditch. He is currently involved in a multicentre research project on the genetics of Dupuytren’s disease.

The joint clinic is sad to announce the untimely death of our friend and colleague Alex Reading.

Alex was an outstanding surgeon whose dedication and commitment to patients and colleagues was second to none.

He was loved and respected by us all and will be deeply missed.

Our thoughts are with his family.

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