Dupuytren's Disease

What is Dupuytren's disease?

  • Dupuytren's disease is a condition that makes some of the tissue in your hand thicken. The tissue may form cords that start on your palm and go to your finger. If the cord contracts (becomes shorter), then your palm or finger may become stuck in a bent position. This is called a contracture. Dupuytren's disease may occur in one or both of your hands. Any finger may become bent, but it is more common in your ring and little finger.

  • Dupuytren's disease is a progressive disease, which means it gets worse over time. Dupuytren's disease may happen many times over your lifetime and your finger may never fully become unbent. Treatment may help decrease your pain. Your finger may become less bent and it may be easier to use your hand.

What causes Dupuytren's disease?

Caregivers do not know what causes Dupuytren's disease. Caregivers believe that Dupuytren's disease may be inherited (runs in the family). Having a family member who has Dupuytren's disease may increase your risk of getting it. Certain diseases that may increase your risk include diabetes (high blood sugar) and HIV/AIDS. Having seizures (uncontrolled shaking) or taking seizure medicine may also increase your risk for Dupuytren's disease. You may have an increased risk of Dupuytren's disease if have had a trauma (accident) to your hand. Lifestyle choices that may increase your risk include smoking and drinking alcohol.

What are the signs and symptoms of Dupuytren's disease?

You may not feel any symptoms at first. When you do have symptoms, they usually become worse over time. The milder symptoms occur in early stages of the disease and the worse symptoms occur in late stages. You may notice that it is hard to do things that used to be easy for you. This may include washing yourself, getting dressed, or putting your hand in your pocket. You may also have any of the following symptoms:

  • Early stages:

    • You feel the skin of your palm becoming thick.

    • You see changes on your palm, including new dimples and pitting.

    • You have bumps on your fingers near your knuckles. These are called Garrod's nodes.

    • You have new tissue covering your knuckles. These are called knuckle pads.

  • Middle stages:

    • You see or feel a raised, firm lump under the skin of your palm or finger. You may feel more than one bump.

    • You see or feel a thick, firm cord of tissue on your palm or finger.

  • Late stages:

    • One or more of your fingers becomes bent toward your palm.

    • Your palm becomes bent.

What other conditions may I have with Dupuytren's disease?

You may also have thick lumps of tissue form on other parts of your body. If you have lumps on the bottom of your feet, you may have a condition called plantar fibromatosis. This is also called Ledderhose disease. If you are male, lumps may form on your penis. This is called penile fibromatosis or Peyronie disease.

How is Dupuytren's disease diagnosed?

Your caregiver will ask about your symptoms and when they started. He may ask if you have had these symptoms in the past. You may also be asked if other members of your family have had similar symptoms. Your caregiver will ask you about your health history and any past surgeries. He will also ask you if you are taking any medications. Tell your caregiver if you have any diseases, such as diabetes or seizures.

  • Physical exam: During your physical exam, your caregiver will check the skin of your hands. He will count any lumps that you may have. If your fingers are bent, your caregiver may measure their angle. Your caregiver may also check your feet for lumps. If you are male, your penis may also be checked for extra tissue.

  • Table top test: Your caregiver will ask you to place your palms flat on a table. He will check if your palms are bent when you try to keep them flat.

How is Dupuytren's disease treated?

You may not need treatment for Dupuytren's disease if your symptoms are mild. Your caregiver will check your symptoms to see if they get worse over time. You may need treatment if your fingers become bent or if it becomes hard to use your hand. You may need any of the following treatments:

  • Injections: Steroid medicine is given as one or more injections (shots) into your lump. Steroids may make the lump softer or less painful. You may need to have this treatment more than once. Proteolytic enzyme medicine may be given as one or more shots into your hand. This medicine may decrease the contractures (muscle shortening) that cause your fingers to stay bent.

  • Surgery: You may need surgery if your hand becomes bent. Even after surgery, your finger or palm may remain partially bent. There are different kinds of surgery that can be done for your condition. You may need any of the following:

    • Fasciotomy: During a fasciotomy, your caregiver uses a special needle or knife to divide cords in your palm or finger. This surgery may be done in your caregiver's office.

    • Fasciectomy: With this surgery, some or all of the thick tissue and cords are removed. Your wound (surgery site) may be closed with stitches or left open to heal on its own. Your wound is covered with bandages. During a fasciectomy, some of your skin may need to be removed. If this happens, your hand will be covered with skin taken from another part of your body.

    • Joint surgery: You may need surgery on your joints. Joints are the places in your body where two bones meet. Joints in your hand include your knuckles and other places where your fingers bend. Your caregiver may do joint surgery to make your joint looser or fixed in one place.

    • Amputation: You may need an amputation if other surgeries do not work for you. During an amputation, part or all of your finger is removed.

What therapies may I need with Dupuytren's disease?

With or without surgery, your caregiver may want you to have special therapies to decrease your symptoms. Therapies may also help your hand function better.

  • Physical therapy: Your caregiver may want you to go to physical therapy. A physical therapist will help you with special hand exercises. These exercises may help make the bones and muscles in your hand become stronger and move better. He may have you stretch your hands, wrists, and fingers in different directions.

  • Occupational therapy: Occupational therapy (OT) uses work, self-care, and other normal daily activities to help you function better in your daily life. OT helps you develop skills to improve your ability to bathe, dress, cook, eat, and drive. You may learn to use special tools to help you with your daily activities. You may also learn new ways to keep your home or workplace safe.

  • Massage therapy: Your caregiver may want you to have massage therapy on your hands. Massage may help decrease your pain and swelling. It may also help prevent scars from stopping your joints from working properly.

When should I call my caregiver?

Call your caregiver if:

  • You have new dimples or dents in your palm.

  • You have trouble straightening your finger or palm.

  • You become unable to use your hand.

  • You have hand pain.

  • You get lumps on the bottom of your foot.

  • If you are male, you have lumps on your penis.

  • You have questions or concerns about your condition, treatment, or care.

Where can I find more information?

You may find it hard to adjust to having hand problems. Talk to your caregiver, family, or friends about these feelings. Contact the following for more information:

  • American Academy of Orthopaedic Surgeons
    6300 North River Road
    Rosemont , IL 60018-4262
    Phone: 1- 847 - 823-7186
    Web Address: http://www.aaos.org/

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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