DUPUYTREN'S DISEASE

What is it?
Dupuytren's disease is an abnormal thickening of the fascia (the tissue between the skin and the tendons in the palm) that may limit movement of one or more fingers. In some patients, a cord forms beneath the skin that stretches from the palm into the fingers. The cord can cause the fingers to bend into the palm so they cannot be fully straightened. Sometimes the disease will cause thickening over the knucles of the finger. It can also occur in the soles of the feet.

What causes it?
The cause of Dupuytren's disease is unknown and there is no permanent cure. The disease is usually painless. This is a non-cancerous condition. Dupuytren's disease mostly affects white people with ancestors from Northern Europe. It occours more often in men than in women, and usually starts after age 40. In many cases, the disease runs in families.

Some people may develop a more severe form of Dupuytren's disease. These may be people who:

• Develop the disease at a young age.
• Have the disease in areas other than the hand.
• Injuries to the hand have not been directly linked to causing the disease.

Signs and symptoms

• Occurs slowly
• Usually noticed as a small lump or pit in the palm
• Tends to occur near the crease of the hand that is closest to the base of the ring and little fingers
• With time, a cord may develop between the palm and the fingers
• Palm cannot be placed flat on even surfaces, such as a table top
• Drawing of the finger into palm

Treatment
There is no permanent cure for Dupuytren's disease. Surgery can relieve the bending of the fingers into the palm, but the condition can return with time. The goal of surgery for Dupuytren's disease is to restore the use of the fingers. Your doctor should advise you on whether surgery is recommended in your case.

Some considerations on surgery:

• Presence of lump in the hand does not mean that surgery is required.
• Bending of the fingers into the palm at the base of the fingers is usually correctable by surgery.
• Surgery may not completely relieve bending of the fingers at the joints in the fingers.
• It is important to remember that surgery is not a permanent cure for this disease. After surgery, thickening of the palm and development of the cord may return in the same place, or a new place within the hand.
• Sometimes skin grafts are needed to cover open areas in the finger.