Dupuytren’s Disease

If the tissue under the skin of the palm thickens, it can cause nodules and cords to occur in the hand. This condition is called Dupuytren’s disease and can be benign, but if the thickening extends to the fingers, it can cause them to contract toward the palm. There are many risk factors associated with Dupuytren’s disease, but no single known cause. It tends to involve both hands.

With this disease, if there is no functional limitation and there is no pain with presence of disease, surgery may not be required. If the disease is mild to moderate and causes a funtional problem surgery or Xiapex (collagenase injections) could be considered. Xiapex injections are a less invasive form of treatment for more simple disease. The collagenase injection contains a protein enzyme that weakens the cord and is therefore injected into the cord. Following the injection the patient goes home and returns to clinic 48 hours after where the finger is gently pushed straight, the cord snaps, the finger straightens and this gives the patient improved movement of the finger and function.

Surgery is required when the patient often cannot put their hand flat on a table or the patient notices a functional limitation or pain due to the disease.  Surgery involves a zig-zag incision  made on the palm and then the thickened tissue is removed. In some cases or in situations where Dupuytren’s disease has recurred, it may be necessary to use a skin graft from the upper arm to reconstruct the skin on the palm. Following surgery, patients can expect to require 2-3 days of rest, followed by a 4-6 week recovery period from any strenuous activity. A splint is used to aid healing and a physiotherapy regimen is essential to success.

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