Dupuytren’s Disease. Am I descended from the Vikings?
Dupuytren’s disease causes an abnormal thickening and tightening of the fascia, beneath the skin, on the palm of your hand. The fascia is a soft tissue that anchors the skin securely to allow you to grip and hold objects.
Dupuytren’s disease is thought to be a hereditary disorder, running in families; however, the exact cause is unknown. There are a number of other risk factors that are believed to contribute to developing Dupuytren’s disease. These include:
Gender: Men are 8x more likely to develop the condition than women.
Ancestry: Much more common in people with Northern European and Scandinavian ancestry.
Alcohol and tobacco use.
Diabetes.
Age: Incidence increases with age.
To answer the question in the title. For a long time Dupuytren’s disease has been termed a ‘disease of the Vikings’. Unfortunately research published in 2019 concluded that there is no genetic evidence that Dupuytren’s disease is of ‘Viking’ origin. But if you want to tell your friends and family you are descended from the Vikings we won’t correct you!
Early Dupuytren’s disease with a thickened nodule in the palm.
Dupuytren’s disease is usually slow to progress and painless condition. Initially firm lumps and pitted skin develop in the palm of the hand. Over time thick, rope like cords can develop and pull the fingers into a bent position. These tight cords make it impossible to straighten your fingers or rest your hand flat on the table. The ring and little fingers are most commonly affected; however, it can occur in all fingers including the thumb.
Common problems reported include difficult shaking hands, putting on gloves, washing your face and putting your hands in your pockets.
Assessment for Dupuytren’s is usually quite simple. Visual examination of the hand is usually enough to identify if you have the trademark thickening, pitting, nodules or cords in the palm of the hand or fingers. These findings are combined with your reported symptoms to confirm that Dupuytren’s disease is the diagnosis and to rule out other conditions that may be affecting your hand(s).
There are several treatment options for those with early or more advanced stages of Dupuytren’s disease.
Hand Therapy:
Unfortunately there is no evidence that hand therapy alone can prevent or treat Dupuytren’s disease. However, we are very involved following the 3 Hand Surgery options below.
More advanced Dupuytren’s disease with a cord pulling the finger into a flexed position.
Radiotherapy:
Low dose radiotherapy may have a role in slowing the progression of early Dupuytren’s disease. It may also help with reducing any discomfort caused by the changing cords or nodules. Radiotherapy is only suitable in the early stages when you can still place your hand flat on the table, meaning hand function is relatively normal. As a result hand therapy is usually not required for these patients.
Hand Surgery:
Collagenase (Xiaflex):
Collagenase is injected, by a hand surgeon, into the Dupuytren’s cord that is causing the finger to be bent. Collagenase works to dissolve and weaken the collagen fibres that make up the cord. In our clinic patients return between 2 and 7 days later and the hand surgeon will inject local anaesthetic and then extend the finger to break the cords and straighten your finger. This is a minimally invasive procedure that is performed in the hand surgeon’s consulting rooms.
Needle Aponeurotomy:
The hand surgeon will inject local anaesthetic and then use a fine needle to pierce the skin and gently cut through the tight cord and straighten your finger. This is also a minimally invasive procedure that is performed in the hand surgeon’s consulting rooms.
Surgery:
The hand surgeon will open the skin and remove any thickened or diseased tissue from the palm of your hand and the fingers involved.
Hand Therapy treatment is highly important following any of the 3 procedures described above. We are most involved following surgery relative to the size of wounds, swelling and stiffness that develops as a result. The common treatments provided include:
Splinting:
A hand or finger based splint will be made by your hand therapist to keep your finger(s) straight and avoid the scar tissue pulling your fingers back into a flexed position. Depending on the procedure and stiffness in your hand the splint may need to be worn at all times for 4-6 weeks or may only need to be worn at night.
Wound and Scar Management:
You may have a wound that needs to be dressed following any of the procedures. We have a range of low profile dressings to assist in wound healing but allow your fingers to move relatively freely.
Once the wounds have healed we focus on softening and flattening the scars to ensure they do not tighten and restrict the movement or function of your hand.
Some of the scar management strategies we may use include massage, vibration, silicone, stretching and ultrasound.
Exercises:
We may prescribe a wide range of exercises to restore normal finger movement and strength following the procedure.
Functional retraining:
We will customise your exercise program to resolve specific problems you may have returning to work, sport or any daily activity your are having difficulty performing.
Our Multidisciplinary Dupuytren’s Disease Clinic:
In conjunction with Hunter Hand Surgery and Genesis Care we have developed a Multidisciplinary Dupuytren’s Disease Clinic to provide comprehensive education and evaluation for patients with all degrees and presentations of Dupuytren’s disease. The clinic involves education sessions provided by Hand Surgeons, Radiation Oncologists and Hand Therapists. There is discussion of all non surgical and surgical options; including an open Q&A session to address any queries. This is followed by an individual patient consultation to discuss your specific options. Essentially we provide a ‘one stop shop’ for all aspects of your Dupuytren’s treatment.
Research:
We are also excited to be involved with world first research into the use of radiation to manage Dupuytren’s disease. This clinical trial is being headed by Genesis care and is comparing the use of radiation to prevent the progression of Dupuytren’s and simply observing the hand over time. The trial also looks at the the use of radiation or observation following surgery, collagenase injection or needle aponeurotomy. Attending the multidisciplinary clinic is an excellent way to learn more and see if you’re suitable to be a part of the research.
For more information about Dupuytren’s disease, our multidisciplinary clinic or the research we are involved with, please give us a call on (02) 4920 6336.