Dupuytren’s is an interesting disease. All humans (and all mammals for that matter) have a layer under the skin of the palm called the palmar fascia. It is there to serve as a firm anchor of the skin to our skeleton.
Dupuytren’s is mostly an inherited genetic disease. The gene comes from Northern Europe, probably Scandinavia to be exact. Some call this condition Viking’s disease. The Viking’s rowed all over the North and the Baltic Seas, leaving their genes where ever they went. So you are born with this condition but something switches the gene on in later years. Nobody really knows what does this but alcohol, smoking, diabetes, epilepsy drugs and hand trauma have all often been offered as a trigger to start the disease.
The disease usually presents as a firm nodule in the palm often in the ring or little finger. Eventually the nodule forms a longitudinal cord which shortens over time. It is the shortening that pulls the fingers in causing the classic Dupuytren’s contracture. Sometimes the skin is pulled into the palm causing small pits in the skin.
NB: We cannot treat Dupuytren’s as it is in your genes. We can only treat the contracture.
When you can no longer place your hand flat on a table and it is progressing.
In this technique a needle is inserted through the skin to puncture and break the cord of tissue that is contracting your finger. This is a very quick procedure done under local anaesthetic. No physiotherapy is needed after this. The main problem is recurrence but it can be repeated. Even though it makes up a high percentage of overall treatment offered, not everyone is suitable to the technique. Find out if your hand surgeon offers the option and whether you are suitable.
Luckily this is not available in South Africa as it is very expensive and often there is no benefit over the needle technique.
The main advantage is a more complete and a longer lasting release with removal of the dupuytren’s tissue. The surgery is substantial and usually requires a general anaesthetic. Post-operative physiotherapy is mandatory and the recovery period can be fairly lengthy.