What does it feel like?
Patients generally describe a nodular lump that forms in the palm just under the skin that can be tender in the early stages. This may develop into a cord, extending up to a finger (usually the ring finger). This cord, over time, will contract, and pull the skin and the underlying finger into a contracted position. This can be extremely annoying, particularly when the finger gets in the way of putting one’s hands into a pocket, or when shaking hands. Many patients will at least notice some skin deformation in the form of pits or dimples in the palm.
What is it?
It is a disease of a component of the skin of the hand called the palmar fascia. In more aggressive forms of the disease, this can affect other parts of the body, such as the foot (where it is called Ledderhose disease) and the penis (where it is called Peyronie’s disease).
What causes it?
It has a genetic component, and has often been referred to as the Viking disease. People of Scandinavian origin are more likely to be affected. Some people have a strong familial history, with relatives also having Dupuytren’s contractures. There are multiple associations with Dupuytren’s, some of which include alcohol consumption, antiseizure medication, and heavy manual labour with and without vibratory tools.
What are my treatment options?
This depends on a few factors, including how much the contracture is affecting your function, which part of the hand is particularly affected by the contracture, and how rapidly the contracture is progressing. Physiotherapy or hand therapy has very limited role in preventing the progression of disease, but may help in maintaining the suppleness of your joints.
At the present time, there is no injectable treatment option in Australia. This treatment option, called collagenase, has a trade name of Xiaflex, and functions to enzymatically break down the abnormal collagen in the cords of Dupuytren’s contracture. While available in some countries overseas, it is not available for use here in Australia.
There is no cure for the underlying cause of Dupuytren’s contracture, but surgery may very well aid in limiting the effect the disease has on your hand function. In cases where patients are unable to get their palm flat onto a table top, or where the contracture involves a finger joint (the proximal interphalangeal joint), there is a role for surgery to aid the restoration of function. Careful assessment by a hand surgeon is necessary to determine whether surgery is indeed needed, and what type of surgery would be best suited to you.