Why is it called Dupuytren’s?
Dr Guillaume Dupuytren was a French surgeon in Paris circa 1790-1832. He had a reputation as an excellent surgeon but not such a nice man. He named this condition after himself. He famously treated the haemorrhoids of Emperor Napoleon Bonaparte. He worked at Hotel Dieu Paris – where his statue exists today, and the medical school is in Rue Dupuytren also.
Who get it?
Dupuytren’s disease is hereditary. It runs in families, especially those with Caucasian Anglo-Celtic-Nordic genetics. It has therefore been colloquially dubbed “the Viking’s disease”. It is most common in Caucasian males aged over 50 years but can occur in females and younger patients. The gene expression varies enormously. The rate of disease progression varies too and can only be determined over time.
What is happening?
Dupuytren’s disease is a thickening and proliferation of the subcutaneous palmar fascia in the palm and in the fingers.
Signs & Symptoms?
As the disease gets worse the affected digits lose the ability to extend (straighten) and the finger remains bent for 24 hours of every day (as opposed to a trigger finger which is more intermittent). A bent finger may get caught in your trouser pockets. It may be awkward and not contribute to your grip; but it is often not painful.
What are the treatment options?
The usual treatment is surgery to remove the cords that are causing the contracted fingers. Dr Kirkham can elaborate on your specific needs as each case is slightly different depending on its severity.
Dupuytren’s surgery should only be undertaken by an experienced hand surgeon. It takes considerable skill and is best performed under loupe magnification, with a general anaesthetic. It is day surgery and skin stitches are typically removed at day 14.
You may have heard about the alternative of treating with injections? The non-operative Collagenase injections were removed from use by the Australian TGA in approx. 2019 due to unsatisfactory recurrence rates (47% at 2 years) and unsatisfactory complications. (Tendon ruptures).
Aftercare post Dupuytren’s treatment?
The recovery time after Dupuytren’s surgery varies significantly between patients. Factors include the pre-operative severity of disease, any PIP joint fixed flexion, the degree of skin shortening & tendon tethered by the diseased fascial tissue. The highly-keratinised, glabrous skin of the palm takes longer to recover than in other areas of skin. The skin hardens in the first month and softens in the second. Hand therapy is often required to regain maximal motion after surgery. Again, this will typically depend upon how it looked before the surgery. The disease can recur.