Dupuytren's Disease and Contracture

What is Dupuytren's Disease?

Fast Facts About Dupuytren's Disease

• It presents as a thickening of the skin of the palm of the hand.
• It's hereditary (Autosomal dominant), especially of "Viking heritage."
• Most common among middle age (40-60) individuals.
• More common in men (Male: Female ratio is 7 to 1.)
• Typically presents with contracture of the metacarpophalangeal joint (knuckle joint) and proximal interphalangeal joint (one of the joints of the fingers.)

Dupuytren's Contracture of the Ring Finger (Photograph Courtesy of Frank C. Muller, Wikimedia Commons)

Associated Diseases

• Epilepsy (most common)
• Alcoholism
• Diabetes Mellitus
• Smoking
• NOT related to manual work.

When would Treatment be Needed for Dupuytren's Disease?

• When there's contracture of the metacarpophalangeal joint or MP joint of >30 degrees
• When there's contracture of the proximal phalangeal joint or PIP joint
• Nodules alone does not need surgery.

What kind of Treatments Available?

• Collagenase injections
• Needle aponeurotomy or percutaneous Dupuytren's Contracture release in selected patients.
• Selective or Extensive Palmar fasciectomy and Dupuytren's contracture release.

I recommend asking one of your Houston Plastic Surgeons about your Dupuytren's disease if it requires treatment or not.

Emmanuel De La Cruz M.D.

Reference:

Badalamente MA, Hurst LC: Enzyme injection as non-surgical treatment of Dupuytren’s
Disease. J Hand Surg 25A: 629-636, 2000.

Burge P, Hoy G, Regan P, Milne R: Smoking, alcohol and the risk of Dupuytren’s contracture.
J Bone and Joint Surg 79B: 206-210, 1997.

Chammas M, Bousquet P, Renard E, Poirier J- L, Jaffiol C, Allieu Y: Dupuytren’s Disease,
Carpal Tunnel Syndrome, Trigger Finger, and Diabetes Mellitus. J Hand Surg 20A: 109-114,
1995.

Critchley EMR, Valcil SD, Hayward HW, Owan VMH: Dupuytren’s disease in epilepsy. J
Neurol Neurosurg Psych 39: 498, 1976.

Ling RSM: The genetic factor in Dupuytren’s disease. J Bone and Joint Surg 45B: 709, 1963.

Starkweather ICD, Lattuga S, Hurst LC, et al. Collagenase in the treatment of Dupuytren’s
disease: an in vitro stud y. J Hand Surg 21A: 490-495, 1996.

Percutaneous Dupuytren's Contracture release

Percutaneous Needle Aponeurotomy for Dupuytren's Contracture ~ Houston Plastic Surgeons

• Percutaneous needle aponeurotomy is a minimally invasive procedure for release of Dupuytren's contracture by dividing the cords percutaneously using a needle.
• A study conducted involving 3736 procedures using this technique reported good results (>70% correction) in 81% of patients
• Complication rates ranges from 3.7 to 8.9% which include nerve injury
• Another study involving 82 patients with 10 year follow-up showed that 2/3 of patients requiring a second release within 5 years
• Recurrence rates of  Dupuytren's contracture after limited local excision ranges from 34 to 66%
• Recurrence rates after extensive excision of the palmar aponeurosis is 11.6%
• Typical recurrence rate after needle aponeurotomy is ~50% in 3-5 years
• Not all patients are candidates for percutaneous needle aponeurotomy
• Long term correction is better maintained in the metcarpophalangeal joint (knuckle joint) than the proximal interphalangeal joint of the finger (70 vs 41%).

I recommend asking your hand surgeon if he/she performs this kind of procedure.  Not all patients are candidates for percutaneous needle aponeurotomy for Dupuytren's contracture.  

Emmanuel De La Cruz M.D.

Reference:

Cheng et al. Needle Aponeurotomy for Dupuytren's Contracture. Journal of Orthopedic Surgery. 2008; 16 (1):88-90

Duthie RA, Chesney RB. Percutaneous fasciotomy for Dupuytren’s contracture. A 10-year review. J hand Surg Br 1997;22:521–2.

Badois F. Non-surgical treatment of Dupuytren’s contracture. Available from: http://assoc.wanadoo.fr/f.badois-dupuytren/html/gbsommaire.html. Accessed 4 December 2006.