An Overview Of Dupuytren’s…And What To Look Out For
⌚️ read time: 6 minutes
Have you recently noticed a lump in your palm?
Or maybe your doctor is concerned you have something called 'Dupuytren’s', and you’re confused about what it is (or even how to pronounce it!)?
About 1 in 20 people will develop this condition, typically in their 50s and 60s. Here’s your introductory guide to help you understand the basics of this condition called Dupuytren’s Disease in the hand.
What is Dupuytren’s Disease? What is Dupuytren’s Contracture?
Dupuytren’s (pronounced DOO-puh-trens) Disease (DD) is a general term for a soft tissue disorder of the hand. Dupuytren’s Contracture (DC) is a more advanced and aggressive subtype of DD that results in stiff contractures of the fingers that often need intervention from a hand surgeon.
So what is DD? In its simplest form, this disease involves fibrotic changes to the palmar fascia. Translation: a thickening of the tissues under the skin of your palm.
The palmar fascia is a thick layer of connective tissue just beneath the skin in the palm. A similar layer exists on the soles of the feet, giving these tissues extra strength to handle repetitive daily tasks such as heavy gripping and walking.
In some people, the disease advances to a DC, where these fibrotic tissues will actually contract and permanently shorten along the lines of repetitive mechanical stress.
What are the symptoms of Dupuytren’s?
Most people will first notice DD in the form of a nodule or small palm mass, most commonly over the palm crease at the base of the ring or small finger. These can be mildly tender or annoying, but typically they are not painful.
Over time, these nodules can evolve into ‘cords’ or linear masses of thickened tissue (see cover image above) in the palm that extend towards and away from the fingers. In those who develop DC, it is these cords that become contractile, resulting in an inability to straighten the finger (see image).
An example of DD that has progressed to DC. Notice the ring finger has become contracted. It cannot be forcefully straightened any further than what is shown. This patient decided to have surgery to correct the contracture.
What causes Dupuytren’s?
Even with our best and most up-to-date understanding of DD, the root cause still remains unclear. Many forms of Dupuytren’s are inherited, meaning you will meet families where multiple members all develop Dupuytren’s later in life.
But the most common form is sporadic, meaning it just happens out of nowhere.
The worst part? There is no cure. We can certainly treat aspects of the condition, but we can’t cure it.
What is the treatment for Dupuytren’s?
Additionally, there is no treatment for DD itself; we have treatment options for DD only when it becomes more aggressive and advances to involve a contracture. Even in this circumstance, the treatment options address the contracture, not the underlying disease (we will get into the specifics of DC treatment in future posts).
In fact, it is for this reason that we, unfortunately, will often see recurrence of the contracture and expansion (evolving new disease in untreated areas) after a previous treatment.
So why do we know so little and why is there no cure? It turns out there are a few reasons why DD has proven difficult to study in the research lab:
There is no good animal model on which to base experiments.
There is no unique biomarker (blood test, gene test, etc) for DD.
While DD appears to have strong genetic traits, a single gene or consistent pattern of genes has not been found. Rather, it appears to be a complex interplay of multiple genes and environmental factors that ultimately leads to the development of DD symptoms.
Who gets Dupuytren’s?
Most people will develop DD in their 50s and 60s. The disease itself is far more common than one might think, appearing in up to 21% of Caucasian males in Western countries by the age of 65!
Female patients lag behind their male counterparts by about 10-15 years, meaning that we typically see this condition more frequently in men than women.
In those who have developed DD, the most pressing question they ask is whether they will develop a finger contracture. Fortunately, the answer is only about 1 in 5 patients who develop DD go on to experience a hand contracture during their lifetime.
Because of the complex interplay among genes and the environment that leads to the development of DD, the disease progresses unpredictably and with variable severity. Some patients very quickly develop severe contractures, while others will grow one painless nodule in their hand and show no further symptoms.
Is Dupuytren’s Disease a cancer?
Dupuytren’s is not dangerous.
This is not a malignant or cancerous growth, and it does not spread from the hands to other parts of the body.
However, it is possible to have a severe form of the disease that causes similar fibrotic fascial thickening to concurrently present in other parts of the body (feet, genitals, etc).
Will my Dupuytren’s get worse?
So can we predict how severe your DD will ultimately become? The answer is…sort of.
There are variables known as diathesis factors (why they have to be named that, I’ll never know) that have been shown together to predict disease severity. No single factor means that your disease is guaranteed to be aggressive.
Instead, the more of these variables you have, the more likely your disease will be an aggressive form. Aggressive DD typically will 1) progress faster and 2) be more likely to return after treatment by a hand surgeon.
The factors involved in ‘Dupuytren’s diathesis’ include:
Age of onset younger than 50
DD symptoms in both hands
Nodules that grow on the back of the knuckles (dorsal Dupuytren nodules)
Nodules that develop elsewhere in the body beyond the hands (Ledderhose Disease, Peyronie’s Disease)
DD symptoms in close family members such as parents or siblings
Male patients
Involvement of the thumb
Involvement of 3 or more fingers.
Notice that the severity of the finger contracture is not a predictor of aggressive disease.
Takeaways:
Dupuytren’s Disease is a common, often inherited, condition of the hand that appears later in life and has variable degrees of severity.
About 1 in 5 patients with the condition will go on to develop a hand contracture associated with the disease, and most of these necessitate treatment.
Dupuytren’s is not a cancer and is not a dangerous condition. However, it can severely limit hand function if the contractures get bad enough.
Dupuytren’s is a complex disease that manifests in many ways, from benign ‘bumps’ in the hand all the way to severe and debilitating finger contractures.
In future articles, we will discuss the treatment options for different stages and types of Dupuytren’s contracture, including new non-surgical treatments that have revolutionized the field over the past 10-15 years.
