What is Dupuytren's?
Dupuytren or officially "Morbus Dupuytren" is a benign disorder of the connective tissue in the palm of the hand. Among other things, the connective tissue in the palm of the hand provides strength to the skin and protection to underlying structures such as blood vessels, nerves and tendons. In Dupuytren's disease, lumps and strands develop from the connective tissue of the palm that can be felt directly under the skin. The strands can cause the fingers to become crooked and unable to stretch.
The cause of Dupuytren's disease is still unknown. Factors that seem to be influential include: smoking, diabetes, epilepsy (medication). Sometimes there is trauma just prior to the onset of the first appearance of Dupuytren's disease.
The disease often occurs within families, indicating genetic predisposition to developing Dupuytren's. The rate at which Dupuytren's develops varies greatly. It usually takes months to years before a crooked finger(s) develops. If the disease is common in the family and if it begins at a young age, the disease usually behaves more "aggressively" and the strands and crookedness of the fingers develop more quickly. Dupuytren is more common in men than in women.
What are the symptoms in morbus Dupuytren?
When Dupuytren's disease is first discovered, the nodules or strands are often still small and do not give curvature to the fingers. Because of this, the discomfort is also usually limited. Sometimes the nodules are sensitive but usually do not cause any pain. When the fingers become further crooked, more discomfort arises, such as putting the hand in a pocket, wearing gloves or holding objects.
Diagnosis
Based on the pattern of symptoms and physical examination, the diagnosis is made. In some cases, an X-ray of the hand may be taken to assess the condition of the joints.
If Dupuytren's is diagnosed, what treatment is chosen depends greatly on the degree of contracture and the degree of symptoms.
Treatment:
Non-operative (conservative) treatment
If the disease is in its early stages, the fingers are not yet very crooked and few restrictions are experienced, it is usually waited on. Hand therapy is not routinely advised but can help with better use of the hand. For bothersome or painful nodules without curvature of fingers, protective gloves can be used.
Surgical treatment
When the crookedness of the fingers prevents the hand from laying flat and the patient experiences functional limitations, surgical treatment may be chosen.
Several options exist depending on the severity and extensiveness of the Dupuytren's, the patient's wishes and the patient's overall condition.
Percutaneous needle fasciotomy
This procedure is possible when the strand formation is present in the palm and the curvature of the finger occurs mainly in the first joint (the MCP joint).
The procedure is performed in outpatient surgery and/or in the outpatient OR. A local anesthetic is given around the strand in the palm of the hand. With a small needle, the strand is pierced in several places and the finger is straightened. After the procedure, you will have a plaster on the palm of your hand that should remain in place for at least 48 hours. You will be given a small bandage for the day of the procedure. When the wounds are completely healed, you can do everything by hand again; Recovery is usually completed after just a few days.
The treatment effect, depending on the patient's shape, often does not last as long as with extensive surgery.
Fasciectomy
When the strand formation is more extensive a several joints are crooked, then a fasciectomy is indicated. This involves complete removal of the Dupuytren's tissue.
The operation takes place in day surgery. The entire arm is numbed by a nerve block or general anesthesia is used. An incision is made in the palm of the hand and all the Dupuytren's tissue is removed. In very severe cases, a skin defect sometimes develops, which then has to be covered with a skin graft from the forearm. Usually the skin can be closed without a graft. Sutures that dissolve in the skin are used. After the procedure, you will have a thick pressure bandage for 5-7 days. After 5 days you will come to the office for wound inspection and be referred to a hand therapist for hand therapy and (if necessary) splint therapy. In some cases, the hand therapist can also do wound inspection and this can be done in 1 appointment.
It is very important to start moving the hand and fingers quickly after surgery for optimal treatment results. Post-treatment, however, is often considered intensive.
During the consultation hour, you will be given further detailed information about the (post)treatment and recovery following the necessary/chosen procedure, and you will be given an information brochure about your specific procedure.
