is a genetically inherited disorder which primarily involves the palmar
aponeourosis and its digital prolongations.
The primary pathological
change is in the fascial tissues of the palm which results in thickening,
cord-like formation of contractile bands, and then eventual contractures
at the level of the interphalangeal joints. On occasion, it can be associated
with other diseases such as diabetes, epilepsy, or alcoholism.
factors increase the likelihood of significant progression. These include
a strong family history, early onset of disease, rather extensive bilateral
involvement, and the presence of disease in other areas such as the plantar
regions of the feet. These contributing factors may lead to a more aggressive
course of the disease and possibly even an operation at an earlier age.
The disease is seen
much more frequently in men than in women and has a tendency to usually
appear between the ages of 40 and 60.
Dupuytren's disease has over a 65% chance of being bilateral, and can
involve other areas such as the foot, the dorsum of the hand, and other
fibrous tissues. It is a slowly progressive disorder which may have periods
of temporary arrest, or even a rapid progression. After the nodules have
formed, the tendency is for these to coalesce into a cord, which will
lead to a flexion contracture at the MCP joints and the PIP joints. The
skin itself can be infiltrated by the disease.
is always non-surgical. This would consist of continued observation for
progression of the problem. As the disease does not involve any pain,
there is no reason for the excision of the nodules or cords until contractures
in digits have occurred. If a contracture becomes bothersome or a nodule
becomes painful, or if the contracture in the MCPJ exceeds 30 degrees
or any involvement at the PIP joint occurs, we would recommend surgical
excision. This would consist of a palmar and digital fasciectomy utilizing
an axillary block anesthetic. A skin graft taken from the forearm is almost
always used. Long term results are usually quite good. If contractures
have developed at the MCPJ and PIP joint, they can usually be corrected
to within half of the preoperative level. Recurrence of the disease is
possible, but this is usually not associated with further contracture