Dupuytren’s disease
What is Dupuytren’s disease?
Dupuytren’s disease is a common, benign condition of the hand.
It affects men more frequently than women and becomes more common with increasing age. The name derives from a French surgeon, Baron Guillaume Dupuytren, who described treatment for the condition at the turn of the 18th century. In Scotland it is sometimes called ‘the curse of the MacCrimmons’, as the condition affected several generations of this famous piping family.
In everyone’s hands there is a fine layer of tissue called ‘fascia’ lying just under the skin of the palm and the fingers. In patients with Duputyren’s disease the fibers of this fascia have a tendency to grow into nodules. These nodules can extend or join together to form longer ropes of thickened fascia (what we call “cords”), which may over time contract and pull the fingers into the palm. This contracture is painless and tends to progress very gradually, but the nodules can be tender and uncomfortable in the early stages when they are growing.
The initial presentation is often with hard nodules appearing in the palm of the hand. Sometimes they can be tender in the phase when they are growing.
As the fibres of the fascia thicken, they form tight “cords” involving the overlying skin, with pits appearing adjacent to the cord. As the cords continue to tighten, they can cause the fingers to progressively bend in towards the palm.
Dupuytren’s disease typically starts in the ring and the little finger in the over 60s, and is commoner in men than in women. However, it is not unusual to see cases starting at a much younger age, or affecting other digits.
Why does it occur?
The disease has a complex genetic basis, but is very common in Scotland and in Scandanavia - hence the suggestion that it originated with the Vikings, who brought the genes to these shores. Occasionally it is associated with other conditions such as diabetes or liver disease.
It sometimes appears for the first time after an injury to the hand or wrist in people who are genetically predisposed.
Does it need treatment?
Many people have early Dupuytren’s nodules in the palm without even being aware of them and no treatment is required. Sometimes nodules are tender in the early phase, but this tenderness tends to settle, and again no treatment is required.
If the nodules progress into cords and produce a contracture, there are several surgical options for straightening the finger, which can be discussed with your hand surgeon.
See our page on treatments for Dupuytren’s contracture.
However, there is no cure for the condition itself - there will always be a tendency for the contracture to recur in the future or new ones to develop to other digits.
FAQs
-
Dupuytren’s disease is a progressive condition - but its behaviour in each patient is very unpredictable. We know that of 10 patients who develop early signs of Dupuytren’s disease , only 1 in 10 need surgery by 10 years, and 3 in 10 by 20 years.
While there are some factors that may make it more likely for Dupuytren’s disease to progress in some patients (such as young age, familiarity, having associate conditions such as Ledderose disease, La Peyronie’s disease or Garrod’s pads (see below)), it is impossible to predict if the disease will indeed progress.
-
A healthy diet is always advisable - but ther is no proof that any dietary changes or supplements affect Dupuytren’s disease.
-
Yes. Smoking is associate with a higher risk of developing Dupuyten’s contracture LINK1
Smoking also increases the risk of complicatios and of poor recovery after surgery for Dupuytren’s contracture.
-
-
Dupuytren’s disease makes it impossible to fully straighten your fingers - it does not affect your ability flex them and to close your hand in a fist.
If you have difficulty closing your fingers, even if you have Dupuytren’s disease, something else is happening.
Our surgeons will be happy to review your hands, help you reach a diagnosis, and se what treatments are available.
Please use the contact us form to tell us of your problem and ask to organise directly a face to face appointment with us at Spire Shawfair Park Hospital in Edinburgh
-
In most cases the diagnosis of Dupuytren’s disease is clinical - no scan is needed.
Occasionally we may recommend a scan (ultrasound scan or MRI) or X-rays if we have a doubt or to investigate additional conditions.
Please notice that any investigation has costs the are additional to the consultation fee, and may need to be organsed on a different day or at a different hospital.
-
Usually blood tests are not needed in the diagnosis or treatment of Dupuytren’s disease.
-
Yes, Dupuytren’s disease has a strong genetic component and often runs in families. If you have developed Dupuytren’s, it means you inherited a mix of genes that predispose you to Dupuytren’s disease. But other environmental factors then intervene during life to stimulate Dupuytren’s to develop.
-
Dupuytren’s disease is a genetic condition, but many factors contribute to decide if a person who is predisposed to Dupuytren’s disease will develop signs of the condition.
It is not unusual for patients not to be aware of any familiarity.
Our surgeons will help you understand if what you have is indeed Dupuytren’s disease, and if and what treatment can be indicated.
-
While Dupuytren’s disease most commonly appears after 50 in men and 60 in women, it can start at any age. It is not rare we are asked to assess patients in whom the disease has appeared as young as in their twenties - or events teenagers.
If you are very young we may at times suggest a scan to confirm our clinical diagnosis.
-
It is not uncommon that Dupuytren’s disease starts to manifest after an injury to the hands - even a minor one. Or sometimes after surgery. They are all events that cause inflammation in your hands.
-
Dupuytren’s disease in the hands is sometimes associated with fibrous lumps in other parts of the body. For example Garrod’s knuckle pads lying over the joints in the fingers; Ledderhose’s disease - nodules in the instep of the foot; La Peyronie’s disease in the penis. These lumps are benign and they usually do not require any intervention. They sometimes appear years ahead of Dupuytren’s disease in the palm.
If you think you have Peyronie’s disease and it is causing you discomfort, you may need to see a urologist.