Dupuytren’s disease is a benign hand condition which affects the tissue beneath the skin of the palm and fingers. It can cause lumps, pits and firm cords in the palm, which may gradually pull one or more fingers into a bent position.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including carpal tunnel syndrome, trigger finger and thumb, thumb arthritis and Dupuytren’s disease.
What is Dupuytren’s disease?
Dupuytren’s disease is a benign condition affecting the fascia, which is the gristly layer of tissue lying just beneath the skin in the palm and fingers.
The condition is more common in men. It takes its name from Baron Dupuytren, a French surgeon who was one of the earliest surgeons to report the condition.
Dupuytren’s disease is not usually painful, although nodules can be tender in the early stages when they are getting bigger. The main problem is that cords of thickened tissue can gradually pull the fingers into the palm, preventing them from straightening so it is difficult to put items into the palm or the finger gets in the way.
What causes Dupuytren’s disease?
The exact cause of Dupuytren’s disease is unknown. It tends to be more common in some families, which suggests that there may be a genetic predisposition.
Dupuytren’s disease is also more common in people who smoke, drink excess alcohol, have diabetes, have liver disease or take treatment for epilepsy.
There is also a geographical pattern. Dupuytren’s disease is more common further north in Europe and the highest incidence is found in Scandinavian countries. This has led to the condition sometimes being referred to as “Viking disease”.
Symptoms of Dupuytren’s disease
Dupuytren’s disease causes thickening of the layer of fascia beneath the skin in the palm and fingers. This may lead to nodules, pits and cords.
Nodules in the palm or fingers
Nodules are small lumps that can develop in the palm of the hand or in the fingers. They may be tender in the early stages but Dupuytren’s disease is not usually painful.
Pits in the skin
Pits are small indentations in the skin of the palm. They may be single or multiple and are caused by the disease pulling on the skin from beneath.
Figure 2: Pits in the palmar skin.
Cords in the palm and fingers
Cords are longitudinal fibrous bands of thickened tissue. They may affect one or more fingers and can gradually pull the finger into the palm.
When a cord causes a contracture, it may no longer be possible to actively or passively straighten the finger. The finger may get in the way when wearing gloves, putting the hand into a trouser pocket or washing the face.
Finger flexion is usually normal and is not affected.
How Dupuytren’s disease behaves
Dupuytren’s disease can behave differently from one patient to another. In some people it progresses slowly. In others, it may have periods of inactivity or progress more rapidly.
- The ring and little fingers are most commonly affected
- Both hands are commonly affected
- The skin is often involved with the disease
- The feet may be involved in a small proportion of patients, called Ledderhose’s disease
- Other body parts may occasionally be affected
- Recurrence after treatment is common
When should Dupuytren’s disease be assessed?
Specialist assessment is recommended if the finger is starting to bend into the palm, if the hand cannot be placed flat on a table, or if the condition is interfering with everyday activities.
Surgery is usually considered when there is more than 30 degrees loss of extension at the finger joints. Put more simply, this is often when it is no longer possible to place the hand flat on a table because the fingers are bent.
Find out what to expect at your outpatient appointment.
Treatment for Dupuytren’s disease
Despite ongoing research into the treatment of Dupuytren’s disease, surgery remains the gold standard effective treatment. The aim is to improve the position of the finger by removing the thickened Dupuytren’s tissue.
In the past, an injection called Xiapex was available but this has now been withdrawn from the UK since 2020. Some early contractures may be suitable for division using a needle inserted in the palm, which is called percutaneous needle fasciotomy. Radiotherapy is available, although this remains a little controversial, but it may be appropriate for certain patients.
Surgery for Dupuytren’s disease
Surgery usually removes the thickened Dupuytren’s tissue through Z-shaped incisions in the palm and finger. If the overlying skin is badly affected or if it is revision surgery, this may be removed and replaced with a skin graft.
The operation is usually performed as a day case procedure using either regional anaesthesia, where the arm is anaesthetised temporarily, or general anaesthesia.
After surgery, a bulky hand dressing usually remains in place for up to two weeks. The stitches are then removed and hand mobilisation begins. Some patients require postoperative physiotherapy, but this is not always required. Others may have a custom-made splint fitted to wear at night until the scar has become soft and mature.
Results of surgery
Surgery can improve finger position and hand function, but it is not always possible to completely correct severe contractures. This can occur even when all visible Dupuytren’s tissue has been removed.
In longstanding contractures, the finger joint itself may have changed and tightened up. This is why early assessment is useful if the finger is becoming increasingly bent.
Possible complications of surgery
Complications following surgery are recognised but infrequent. Possible complications include:
- Wound infection, which occurs in approximately 1% of cases
- Temporary scar tenderness, which is very common
- Finger stiffness, which is reduced by early mobilisation and careful surgery
- Nerve injury, which may result in permanently altered feeling in the finger
- Bleeding
- Recurrence of the disease and contracture
- Arterial injury and loss of a finger, which is very uncommon
Concerned about a bent finger or lump in the palm?
If you have nodules, cords, skin pits or a finger that is gradually bending into the palm, Mr Robert Farnell can assess your hand and advise whether monitoring or surgery may be appropriate.
Dupuytren’s disease FAQs
These answers are provided to help patients understand the key points about Dupuytren’s disease, symptoms, progression and treatment options.
What is Dupuytren’s disease?
Dupuytren’s disease is a benign condition affecting the fascia beneath the skin of the palm and fingers. It can cause nodules, pits and cords that may gradually pull the fingers into a bent position.
Is Dupuytren’s disease cancer?
No. Dupuytren’s disease is benign. It is not cancer, although it can progressively affect hand function if the fingers become bent into the palm.
What causes Dupuytren’s disease?
The exact cause is unknown. It is more common in some families and may be associated with genetic predisposition. It is also more common in people who smoke, drink excess alcohol, have diabetes, have liver disease or take treatment for epilepsy.
Why is Dupuytren’s disease called Viking disease?
Dupuytren’s disease is more common in northern Europe, and has its highest incidence in Scandinavian countries. This geographical pattern has led to it sometimes being called Viking disease or Viking finger.
What are the symptoms of Dupuytren’s disease?
Symptoms may include lumps in the palm, pits in the skin and firm cords that pull one or more fingers into a bent position. The ring and little fingers are most commonly affected.
Is Dupuytren’s disease painful?
Dupuytren’s disease is not usually painful. In the early stages, nodules in the palm can sometimes be tender.
Which fingers are most commonly affected by Dupuytren’s disease?
The ring and little fingers are most commonly affected, although other fingers and the thumb may also be involved.
When should Dupuytren’s disease be treated?
Treatment is usually considered when the finger cannot straighten fully, when there is more than 30 degrees loss of extension or when the hand cannot be placed flat on a table.
What is the tabletop test for Dupuytren’s disease?
The tabletop test is a simple way to assess finger contracture. If the hand cannot be placed flat on a table because one or more fingers are bent, specialist assessment is recommended.
What is the best treatment for Dupuytren’s disease?
Surgery remains the gold standard effective treatment for Dupuytren’s disease when the finger contracture is significant. The operation usually removes the thickened Dupuytren’s tissue to improve finger position.
Can Dupuytren’s disease come back after treatment?
Yes. Recurrence is common. Dupuytren’s disease can return after treatment or progress in another part of the hand. This is one reason why it is not excised unless it is causing a contracture.
Can severe Dupuytren’s contracture always be fully corrected?
Not always. In longstanding severe contractures, the finger joint itself may have tightened. This can limit how fully the finger can be straightened, even when the Dupuytren’s tissue is removed.