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Treatment for Dupuytren's Disease

10 October 2016

Dupuytren’s contracture is a common, painless and benign condition affecting the hands and fingers. The disease causes a progressive deformity resulting in one or more fingers bending into the palm of the hand. It can affect one or both hands, and sometimes the thumb.

Dupuytren’s disease occurs when there is a build-up of thick fibrous tissue in the palm that radiates into the fingers. Often the tissue initially thickens in one area forming a small 1cm hard lump called a nodule under the skin of the palm. The nodule sometimes feels tender to begin with, but this usually passes with time. Over time, the nodules can extend and form cords of tissue that pass down into the finger. These cords can shorten and contract pulling and bending  the finger in towards the palm. These contractures often cause a gradual bend initially but get steadily worse over time.

Who’s affected

In the older population, Dupuytren’s is found in up to a third of people although it can also affect younger people and is much more common in men. The exact cause of Dupuytren's contracture is unknown, but it’s thought to be related to your genes, as it often runs in families.

If you have the gene that causes Dupuytren’s contracture, other factors such as diabetes, smoking and certain medications (for example, medication for epilepsy) may activate the condition. However, it's not clear how significant these factors are.

Treatment

Many cases of Dupuytren's contracture are mild and don't need treatment, however it may be helpful if the condition is interfering with the normal functioning of your hand.  Disability can affect common everyday tasks, impact on the quality of life and the cosmetic appearance of the hand.

There are several treatment options currently available that can significantly improve hand function, however early assessment is key as the results can deteriorate in advanced cases of the disease caused by a delay in diagnosis.

  • Collagenase injections - the procedure is performed in an out-patient department and involves giving an enzyme injection into the cord. Over the next day or two the enzyme dissolves the cord so that the finger can be manipulated straight after a couple of days under local anaesthetic. Mr Mike Hayton, Orthopaedic Hand and Wrist Surgeon, was the first UK consultant to offer the injection outside clinical trials and has performed more 500 injections. He has found patients return to normal function within a few days including general day-to-day activities and even playing golf.
  • Radiotherapy - this is reserved for progressive early stage disease where it affects the palm with only minor finger deformity. An Orthopaedic Hand and Wrist Surgeon, like Mr Mike Hayton, will assess suitability and refer to a consultant oncologist who specialises in radiotherapy such as Dr James Wylie at The Christie Clinic. Dr Wylie is one of a few oncologists nationally with significant experience in treating this condition.  In the majority of patients, this simple, safe and pain free treatment is can halt the progression of early stage Dupuytren’s disease in the majority of patients.
  • Surgery – medical advances now mean that surgery can be performed by a specialist with the patient wide awake, under a local anaesthetic, and without the use of a tight upper arm tourniquet. Overall, this technique is favoured by patients rather than a traditional general anaesthetic. All stitches are fully dissolvable and the rehabilitation is usually co-ordinated by a hand therapist.

Mr Mike Hayton is an Orthopaedic Consultant specialising in Hand and Wrist injuries at HCA The Wilmslow Hospital and The Manchester Institute of Health & Performance. He has a special interest in small joint arthritis and joint replacement surgery, and has treated many of the UK’s professional athletes including a number of medal winning Rio Olympians. For more information or to book an appointment please call 01625 545 036.

Dr James Wylie is Consultant Oncologist specialising in radiotherapy for Dupuytren’s Disease at The Christie Clinic. For more information or to book an appointment please call 0161 918 7296 or visit www.thechristieclinic.co.uk

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