Patients with Dupuytren’s Disease develop a cord, or cords, in the palm of their hand. The cords may cause a bump, a dimple in the skin, or develop into a cord that may cause the contracture of one or more fingers. The disease is also known as Viking’s disease and has a defined pattern of genetic inheritance. The disease usually has a slow onset starting later in life, usually in the 60-70 year age range and is more common in men.
It is not uncommon to have a family history with one or more family members presenting with the disease. Some research has correlated activities with the progression of disease such as alcohol consumption, smoking, and type of work however, this does not always correlate with clinical findings.
There are several treatments available to either disrupt or remove the cord. The most conservative treatment is injecting the cord directly with an enzyme that degrades the protein allowing a cord disruption and consequent straightening of the finger. Most often the injection is covered fully or partially by insurance. The injection procedure is done in the clinic and 1-2 weeks later the patient returns and if the cord hasn’t separated prior to their appointment this is separated in the clinic under local anesthesia. Most cords are released, however, as more data is collected the recurrence rate appears to be higher than what was first estimated and some surgeons feel that rate is too high.
Another clinic procedure is dividing the cord using a hypodermic needle. This is known as a needle aponeurectomy. This procedure is done using local anesthesia and is done “blindly”. The needle is inserted into the palm after the patient has been injected with local anesthesia. The needle is then used to divide the cord in multiple areas. Once this is completed, slight pressure allows the cord to release and the finger can be straightened. The drawback for this procedure are, again, a high recurrence rate. As the needle is inserted and manipulated blindly, there is also and increased risk to injuring the nerves and arteries in the hand, although using ultrasound does decrease the risk.
Operative treatment has the best outcome based on the low recurrence rate. The cord is either divided segmentally or removed completely in the operating room under visual magnification. Not only is the recurrence rate lower, if done correctly the nerves and arteries in the hand are preserved . The drawback for this operation is the scar on the palm of the hand which takes longer to heal than more conservative treatment. Surgery for full or partial cord removal can be done with either general anesthesia, local anesthesia with sedation, or in some case local anesthesia while the patient is awake.
Regardless of treatment, it is common to undergo some splinting and therapy to improve the extension of the finger (s) and improve the healing of the post operative scar.