This month GP, Alice Fitzgibbon talks Dupuytren’s Disease.
This month’s article is about a condition called Dupuytren’s disease or contracture. Many people might be aware of this condition or have seen it before but, in the advanced stages, it can cause fingers to curl in towards the palm of the hand. Dupuytren’s disease is a condition that can have a significant impact on quality of life, rather than being a significant threat to health. With restricted finger movement can come reduced function of the hands. This may make it very difficult for people to carry out their daily activities and be very frustrating.
Dupuytren’s is a condition that affects the fascia – a layer of fibrous tissue that lies beneath the skin in the hands and fingers. Over many years, this layer of tissue can thicken and tighten. The first sign of this is often lumps, dimples or ridges that can be seen or felt on the palm of the hand. These are not painful but it may progress to pull the fingers over and in towards the palm – where they cannot be straightened out again – and this is called Dupuytren’s contracture. In the early stages, there is no treatment. Some people may have early Dupuytren’s nodules (lumps) that never end up getting worse. If there are early symptoms, watching and waiting to see what happens is the best option.
Some people are more likely to develop Dupuytren’s disease than others. The exact cause of this condition is unknown but you may be at increased risk if you are male, have other family members affected by it, you are a smoker or a heavy drinker, or you suffer from epilepsy or diabetes.
So, when is the right time to see the doctor? The right time to see your GP is when you find your fingers are starting to bend forwards and it is having an impact on how you use your hands – in other words, when you have developed a contracture. Your GP will examine your hands and may refer you to a specialist hand team. There are different treatment options for managing contractures and the best option for you will be decided by the specialists.
One way to treat the contractures is to have an operation. Called a fasciectomy, cutting the tissue allows the surgeon to straighten the fingers back up. This operation may take months to recover from, and the fingers may never be fully straight, or as strong again. However, it does help improve function of the affected hand.
Another option is a procedure called a needle fasciotomy. This is when instead of opening up the hand and cutting the contractures, a needle is inserted into the contractures at several points on the palm. This helps loosen the tissue and may help the finger straighten. It is less effective than surgery, but has a much faster recovery time. With both of these options, given the condition cannot be cured, the contractures may well return.
New developments in treatment of Dupuytren’s contracture are becoming available too. Injections of an enzyme called Collagenase can be used to help dissolve the contracted tissue in the hand and allow the fingers to be straightened up. This treatment may or may not be available on the NHS in your area; sometimes people will pay for this treatment privately.
Dupuytren’s disease can be mild and cause no problems for a lot of people. In others that go on to develop contractures, there can be a lot of difficulties with hand function day-to-day. If you are concerned about your hands and the early development of contractures then please see your GP for a review so a plan can be made should the contractures become more severe.
For further information on Dupuytren’s disease from the NHS visit https://www.nhs.uk/conditions/dupuytrens-contracture/