DUPUYTREN`S DISEASE

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It is abnormal thickening of the fascia which is just under the palmar skin and protects the passing tendon, nerve and vessel structures. Fascia thickening starts from palm and extends to the fingers. In advanced terms of the disease, distortion through the palm and some hardness called nodules arise. (Figure 1)

 

This disease may be also seen in the sole and penis.

It is usually observed in men over 40. While observation frequency is more in diabetic patients, relationship with other occupational diseases is not proven. It may affect all fingers as well as frequent in small and middle finger.

Swelling and bending increase are seen in the examination. Cord shaped thickened indurations related with swellings are handled in the palm. Distortion due to cord pulling occurs in finger in advanced terms of the disease. Both hands are affected in most patients. If the disease starts in the early age, it progresses more serious.

Palmar nodules formed due to dupuytren`s disease are typically painless. The disease is first noticed with disability to put the palm on flat surfaces. When distortion increases more and more, difficulty in some movements such as hand washing, hand shaking, wearing gloves, holding something etc. occurs. Progress rate changes from patient to patient.

If functions of the patient in the initial term are not affected, the patient is followed. If there is no distortion on fingers, existence of nodules does not require the surgery. Steroid injection on nodules may decrease the progress rate of the disease in these cases. In cases that fingers distort 70 degrees and over, surgery is considered. The purpose for surgery is to remove hardened fascia extending to the palm and fingers by protecting the vessel and nerve structures. Deficiencies that may arise in the skin cover after removal of the hardened bands are solved by skin grafts taken from other parts of the body. Brace application after the surgery and physical treatment are very important in terms of success of the treatment.

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