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Dupuytren's Disease

What is Dupuytrens Disease?
 
It is a contracture of the normal fibrous layer of tissue in the palm. It frequently runs in families and there is higher incidence in people who have epilepsy, diabetes and excess alcohol intake.
 
What are its features?
 
The disease usually starts as firm nodules in the palms of the hands which progress to form hard bands or cords which are likely to extend from the palm to the fingers, leading to deformity and difficulty straightening the fingers. It is not usually a painful condition.
 
Firm nodules can develop on the back of the fingers (knuckles pads) and can also rarely affect the soles of the feet where painful nodules develop. Occasionally it can affect the penis (peyronies disease).
 
Does it affect all the fingers?
 
The disease can affect any of the fingers of either hand but the most common to be involved are the little and ring fingers. The disease affects both hands in about 60 per cent of cases and the thumbs are
occasionally involved.
 
Can I prevent the disease from progressing?
 
No; however, keep the skin of the palm and fingers healthy by massaging the skin with lanolin cream or a skin lubricant (e.g E45).
 
Can this disease be related to my work?
 
There is no evidence that suggests this condition is work related.

What are the treatment options for this disease?
 
1. Steroid injections this is only indicated for painful nodules in the palm of the hand in the early stages without associated deformities.
 
2. Fasciotomy - this is an operation under local anaesthetic to divide the tight bands which cause flexion or bending of the knuckle joints.
 
3. Fasciectomy - this entails surgical excision of the disease from the palm and the affected digits. It is usually indicated when one or more of the finger joints are bent over 30 to 40 degrees.
 
4. Fasciectomy Skin Graft if the deformity is severe, the skin is badly involved or there has been previous surgery, a skin graft may be required.
 
5. Amputation in advanced cases, often with previous surgery this may be considered if the chances of corrective surgery succeeding are small.

The Manchester Orthopaedic Group has three hand and wrist surgeons. Steve Royle , Jochen Fischer and Mohammed Waseem are established consultants. They are able to offer a range of treatments for various conditions from carpal tunnel syndrome to wrist arthritis.

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