Hand and Wrist problems

 

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Dupuytren’s disease
03:20
 

Dupuytren's Diseases (bent fingers)

Dupuytren's disease is an inherited (genetic) lifelong condition that leads to progressive contractures of the fingers, usually beginning in the little and ring fingers. It is caused by thickening of the tissues under the skin called cords (it has nothing to do with the tendons). It rarely occurs in the feet, and even more rarely in the penis, but does not occur anywhere else in the body and is not harmful for your overall health.


Dupuytren’s contractures do not need treatment until they start to affect the function of your hand. A rule of thumb is that if you can no longer put your hand flat on the table, then it’s time to intervene. The treatment options are either accepting the finger or fingers as they are although they are likely to get progressively more contracted (if the fingers get too contracted, it may become impossible to straighten them). The first treatment option is to divide the cord with a needle, a “fasciotomy”, which helps to straighten the finger but does not remove the  cord. This is a good option if the disease is fairly mild. If the disease is more advanced, this is unlikely to work. In these cases I recommend a “fasciectomy” which means removing the Dupuytren´s tissue and straightening the finger. A fasciectomy gives a longer lasting result than a fasciotomy but has higher risks. The operation is normally performed under a local anaesthetic (you are awake), unless you prefer to go to sleep. A zig zag incision will be made over the affected fingers, the diseased tissue removed and the fingers straightened. If the disease is particularly severe, a skin graft, normally taken from the crease of the elbow, is sometimes necessary. The wounds are closed with dissolving stitches. Patients normally go home on the day of surgery. A bandage may be applied to the hand to provide compression and splinting and this should be removed 7 days after surgery unless I advise you to keep it on longer because you have a skin graft. You will still be able to move the unaffected fingers and you should maintain their range of motion from the day of surgery by repeatedly making a fist and then fully straightening your fingers. You will have an adhesive dressing on the wound that you should remove at home 7 days after surgery. The dressing is likely to be bloodstained. If you do experience persistent bleeding that is soaking through the dressing, you should apply firm continuous pressure for 15 minutes. If it doesn’t settle, please telephone the hospital where you had the surgery. You do not have to reapply a dressing unless you wish to do so. I recommend applying Vaseline to the wound for at least a week after removing the dressing. It's important to keep the hand elevated (certainly not in your pocket) for the first few days but you must also keep your elbow and shoulder mobile. For most patients a sling is unnecessary. An ideal position is sitting on your sofa with your elbow resting on the arm rest with your hand level with the top of your head. Most patients do not require physiotherapy, but if you are struggling to regain the movement in your hand, please let my secretary know and I will refer you to the hand therapist. Some patients may require splinting after surgery. Your will be hand sore and swollen for several weeks afterwards and will be less dexterous and useful than normal. I recommend you do not drive until your wounds have healed and pain is minimal. You may need a bit more help with activities of daily living. You may need to take a week or more off work, particularly if you have a manual occupation. You are likely to have some discomfort, particularly lifting heavy objects, for several weeks afterwards. You should massage the scars and affected fingers daily once the wounds have healed, for the first three months after surgery. This will help to soften the scars and reduce swelling. The surgery is successful in the majority of patients although the fingers do not always regain full straightening. 


The risks of surgery are bleeding, infection, scarring which may be very thick, delayed healing, recurrent contractures of the fingers, recurrent Dupuytren´s disease in the same fingers or elsewhere, swelling, stiffness of the hand, nerve injury causing numbness, problems with pain including complex regional pain syndrome (a condition of pain and swelling of the whole hand that can be difficult to treat). It is important to understand that a poor outcome from surgery may make the undertaking of your occupation and hobbies more difficult than is currently the case.

 

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