Dupuytren’s Disease

J. Clinton Merrick, MD
Hand Surgery
Rucker MD Plastic Surgery Clinic, Eau Claire

Dupuytren’s Disease is a condition of the hand characterized by the development of scar tissue under the skin that results in progressive deformity of the hand and loss of function. Although there is no known cause of the disease, there is a strong family inheritance pattern. The disease is thought to have originated in Scandinavian people, possibly spread by the invasions of the Vikings. Dupuytren’s is known by many names, ‘Viking’s Disease,’ ‘The Hand of Benediction’ and ‘Bagpiper’s Curse.’ Dupuytren’s disease is especially common in western Wisconsin due to a higher percentage of the population being of Northern European and Scandinavian descent.

A small incision is made in the palm of the hand to remove nodules.

Dupuytren’s disease is essentially a scarring of the tissue under the skin in the palm and finger. It often begins as a small knot or nodule under the skin in the palm. These nodules are composed of the same tissue found in scars. Small pits may also be evident around these nodules. Over time, the nodules grow under the skin into the fingers. Occasionally the soles of the feet, or the penis in men, can also be involved. Small muscle fibers in the scar tissue begin a slow unyielding contraction that flexes the fingers into the palm. Over time, the delicate joints in the fingers become irreversibly damaged and loose the ability to ever straighten again. The slow contraction of the dupuytren’s tissue stretches and moves the vital blood vessels and nerves of the fingers into new anatomic locations that can result in damage during surgery. Through careful dissection, and thorough knowledge of hand surgical anatomy, injury to these structures can be avoided.

Over the years, many habits, vocational activities and conditions have been associated with the disease. However, alcohol consumption, smoking, repetitive activities at work and injury have not been scientifically linked to the disease. Family history and some anti-epileptic medicines remain the only known contributory factors. As much as 5% of the American population is affected, but the incidence is as high as 40% in Scotland and some Scandinavian countries. Men are affected more often than women and men have a more severe form of the disease. The ring finger is most commonly affected, followed closely by the small finger, the middle and the thumb. In only rare instances is the index finger involved.

Dupuytren’s is usually diagnosed by the patient or primary care physician, but early evaluation by a surgeon specializing in hand surgery is crucial to prevent irreversible damage to the hand. Nodules, pits or hard cords in the palms or fingers suggest the diagnosis and any finger bending virtually confirms it. Due to the intolerance of the small joints of the fingers to prolonged flexing, any constriction or flexing of the fingers is cause for alarm and must be evaluated. Treatment is aimed at carefully removing the diseased tissue and restoring function to the involved fingers. The surgery is an outpatient procedure performed with local anesthesia and a mild sedative. The recovery period is about two weeks and return to work is expected in three weeks without restrictions. Complications are uncommon and results are excellent.

In summary, Dupuytren’s disease is a condition affecting the hand that can result in progressive, irreversible loss of function and deformity. Early diagnosis and intervention are essential.

For more information about Dupuytren’s disease or to schedule an appointment with Dr. Merrick, RuckerMD Plastic Surgery Clinic, call 715-833-2116, 800-456-8222 or visit www.ruckermd.com. Dr. Merrick also sees patients in Chippewa Falls and Rice Lake.