There is a layer of tissue,called fascia, under the skin of palm which helps to keep the skin from sliding around when we grip things. In some people, this tissue thickens and shrinks, and pulls on the skin and and on the fingers(figure 1).
Dupuytren’s disease is observed usually in men over 40. Frequency is more in diabetic ones. Ring and small fingers are affected more. Any relationship between patient’s occupation and the disease is not proven.
Swollen and bent fingers are seen in the examination. Extension is limited depending on the severity of the disease. Palmar noduls are typically painless. Sometimes it is confused with trigger finger at the early stages. Patients have serious difficulties in hand washing, hand shaking, wearing gloves etc….. Progress rate changes from patient to patient.
Existence of nodules is not an indication for surgery itself. Steroid injections on nodules may decrease the rate of progression in selected cases. If the angle between the affected finger and palm is equal or more than 70 degrees, surgery is considred. The affected part of the palm fascia and its extensions are removed. To be able to protect vital structures such as vessels, nerves and tendons is important. Sometimes skin grafts from other parts of the body may be needed.
Wound care, massage, exercises and splinting is important to get the best result and prevent recurrence.