Dupuytren disease is a relatively common hand condition that can cause thickening and tightening of tissue beneath the skin of the palm, leading to finger contractures and limited hand function. Named after the pioneering French surgeon Guillaume Dupuytren, this condition is often hereditary and most frequently affects people of northern European descent. In this post, Dr. Joseph Schreiber explains the symptoms to watch for, the natural progression of the disease, and the variety of modern treatment options—from minimally invasive injections to traditional surgery—that can help restore hand movement and improve quality of life.
By Dr. Joseph Schreiber Hand and Wrist Specialist
What are the Symptoms of Dupuytren Disease?
Patients with Dupuytren disease oftentimes will first notice small nodules or dimples in the palm of their hand. This scar-like tissue can progress and consolidate into “cords” along the palm or fingers. If these cords thicken and shorten, they can cause the fingers to progressively curl up into the palm. This is oftentimes concerning for patients because of either the appearance or the functional limitations that can result. Patients with contractures of their fingers may have a difficult time putting their hands into pockets or gloves, or fully opening their hand to grasp objects such as steering wheels or golf clubs.
Patients often ask what to expect once early signs are seen. Studies following patients with Dupuytren disease over time have shown that it can occasionally worsen, stay the same, or actually improve. Unfortunately, we have no good tools available to predict which one of those three categories an individual will fall into – only time will tell.
How is Dupuytren Disease Treated?
There are many treatment options available to patients with Dupuytren disease. While it is always an individualized decision between the patient and physician regarding when to start intervening, typical guidelines include a contracture of the metacarpophalangeal joint (where the finger meets the palm) of 20-30°, or any involvement of the finger joints. Treatment options other than “watchful waiting” include needles or surgery.
Needles can be used to either cut the cord, typically done in an office setting under local anesthesia through the skin, or to inject a medication to digest the cord. One of the notable advancements in the field of hand surgery over the past decade was the FDA approval of a drug called Xiaflex. This medication is a collagenase, meaning that it is an enzyme that digests collagen, the scar-like material that makes up the cords. Xiaflex is injected into the cord, and the patient returns within one week to have the finger stretched back out to a straightened position. Oftentimes, patients will feel the cord pop or snap before they actually come back for a stretching, such as when lifting a bag of groceries. In the initial Xiaflex study published in the New England Journal of Medicine, the average patient had about a 75% improvement in their contracture after treatment. Advantages of this technique include its minimally-invasive nature, but there are small side effects seen, such as itching, bruising, discomfort, and occasional skin disruption during the stretching procedure. Five-year follow-up results of the early patients were recently published and showed that the Dupuytren disease can occasionally come back. This occurs more commonly when it involves the finger rather than the palm.
The tried-and-true treatment option, as first done by Guillaume Dupuytren himself, involves removing the scar-like collagen tissue surgically through an incision along the palm. Regardless of treatment type, patients are typically given a splint to wear at nighttime for the first 4 months after treatment, to prevent recurrence, but will typically have unlimited use of the hand during the daytime. Dupuytren disease tends to be unpredictable, but many treatment options are available if it seems to be progressing.
Expert Hand and Wrist Care at Raleigh Orthopaedic
If you’re experiencing finger stiffness, pain, or locking that may be caused by trigger finger, the fellowship-trained hand and wrist specialists at Raleigh Orthopaedic are here to help. Our team offers both non-surgical and surgical solutions tailored to your specific needs, and we work closely with in-house physical and occupational therapists to ensure a smooth recovery.
Whether your symptoms are new or have been progressing over time, early evaluation is key. Schedule a consultation today and take the first step toward relief and restored function.
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Disclaimer: The information on this site is for general informational purposes only and is not intended as medical advice. It should not be used as a substitute for professional diagnosis, treatment, or medical judgment. Always consult a physician or qualified healthcare provider with any questions you may have about a medical condition or treatment.