Morbus Dupuytren

Dupuytren's disease is a non-painful disorder of connective tissue that lies under the skin of the palm. It is characterized by a benign thickening or knots, which usually occurs in the mobile, soft region near the finger joints.

Most commonly, the ring finger and small finger are affected. Eventually, the knots of tissue create a thick cord that pulls one or more fingers into a bent position and impairs their straightening. This can complicate everyday activities, such as writing, typing, using knife and fork for dining, or using a keyboard, playing musical instruments and performing sports requiring manual handling.

The typical signs of Dupuytren's disease are

  • swelling of the tissue layers in the palm,
  • palpable cords under the skin of the palm, and
  • increasing inability to straighten one or more fingers.

Dupuytren's disease is not curable, but several treatments are available to slow its progression and relieve symptoms. Treatment generally is aimed at improving the use of the hand. This can be achieved either by a surgical procedure or a non-surgical treatment, or with a combination of both.

With surgery, the diseased cord is removed under local or general anesthesia. This is followed by physical therapy and recovery may take some time. A minor invasive intervention is needling or percutaneous fasciotomy. Here, a special needle is inserted through the skin under topical anaesthesia to puncture and break the tissue cords that cause contraction of the fingers.

A non-surgical treatment, the so-called collagenase therapy, is performed by injecting an enzymatic drug. This substance dissolves the connective-tissue cords or collagen fibers in the palm over several days. After 24 to 36 hours following the injection, a manual straightening of the bent fingers is started by the treating physician.

With this latter performance, the flexibility of the finger movement is slowly restored. The long termed success of this method involves the patient's own activities, because he or she must exercise and repeat the finger stretching several weeks following the operation, while the fingers are stored in a rail at night.

Each of the procedures has its specific advantage and disadvantage, which have to be discussed individually between you and your physician.

Generally, the non-surgical methods will have significantly less hemorrhage formation and an earlier restoration of the finger straightening. The success rates may vary with the patients condition, but seem to be in a range around 70% in the long-term monitoring of 5 years for all of the aforementioned procedures.

You can find out more about the individual treatment methods for example on http://www.mayoclinic.org/diseases-conditions/dupuytrens-contracture/basics/definition/con-20024378 (English) or http://www.krummefinger.at/es-liegt-in-ihrer-hand (German)

For collagenase therapy, search YouTube for https://www.youtube.com/watch?v=FpoK5R3veSM

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