What is Dupuytren's disease?

Dupuytren's disease is a condition of the connective tissue in the palm of the hand, in which the palmar fascia, the tissue located under the skin of the palm, thickens and tightens. This results in the formation of hard nodules or cords in the palm, which can eventually cause one or more fingers to bend into a curled position. In severe cases, the affected finger can no longer be straightened, making everyday actions such as gripping or holding objects difficult or impossible.

The diagnosis and treatment of Dupuytren's disease fall under regular medical care and usually take place in hospital.

How does Dupuytren's disease develop?

The exact cause of Dupuytren's disease is not fully known, but there are several risk factors that can contribute to the development of the condition:

Genetic predisposition: Dupuytren's disease often runs in families, which suggests that heredity plays a role.
Age and sex: The condition is more common in men over the age of 50.
Lifestyle and health factors: Smoking, alcohol use and certain conditions such as diabetes and epilepsy are associated with an increased risk of Dupuytren's disease.
Occupational strain: Although the term “coachman's hand” suggests that the condition is caused by heavy manual labour, there is little scientific evidence that physical work leads directly to Dupuytren's disease. The name comes from the historical association with coachmen who held the reins for long periods.

What are the symptoms of Dupuytren's disease?

Dupuytren's disease develops slowly and usually starts with a thickening of the skin in the palm of the hand. The main symptoms are:

Nodules or cords: Small nodules or tight cords can form in the palm of the hand and gradually become harder.
Finger contracture: As the condition progresses, one or more fingers, usually the ring finger and little finger, can bend inwards towards the palm and it can become difficult to straighten them fully.
Limited hand function: The bending of the fingers can make it harder to grip objects or carry out everyday tasks.
Pain: Although pain is not always at the forefront of the medical description of Dupuytren's disease, many patients do experience pain. This can range from tenderness to the touch to constant pain that gets worse when using the hand (for example when gripping or moving the fingers). The pain may be related to pressure on small nerves, tension in the connective tissue or irritation from the hardened areas.

How is Dupuytren's disease treated?

The treatment of Dupuytren's disease depends on the severity of the condition and the extent to which hand function is affected. Treatment options range from non-invasive to surgical procedures:

Observation: In mild cases, where the fingers are not yet significantly bent, a wait-and-see approach can be taken with regular monitoring of progression.
Needle aponeurotomy: A minimally invasive procedure in which a needle is used to break through the cords in the palm, which can allow the finger to straighten partially again.
Enzymatic fasciotomy (collagenase injection): An enzyme is injected into the cords to break down the connective tissue, after which the finger can be straightened manually. This method is no longer used.
Surgery: In severe cases, surgery may be needed to remove the thickened tissue and bring the fingers back into a normal position. This is known as fasciectomy.
Physiotherapy: After treatment, physiotherapy can help restore hand function and improve the flexibility of the fingers.

What is the difference between Dupuytren's disease and other hand conditions?

Dupuytren's disease is sometimes confused with other conditions that also cause contractures or bending of the fingers, such as trigger finger or osteoarthritis. The distinguishing feature of Dupuytren's disease is the thickening and hardening of the connective tissue in the palm, which leads to a gradual, permanent bending of the fingers. Unlike trigger finger, for example, where a finger suddenly gets stuck in a bent position and then snaps loose, the bending in Dupuytren's disease is permanent without treatment.

Dupuytren's disease is a chronic condition that can considerably affect hand function, but with the right treatment its progression can be slowed and hand function can be improved.

At Kliniek het Bolwerk in Haarlem, you can come to us for trigger finger.