by Jennifer Delliskave

It often starts as a small, firm, usually painless lump in the palm of the hand, just under the skin. At first, it may be so small that it goes unnoticed. Over time, however, the lump becomes larger and cords of collagen tissue form under the skin, spreading toward the fingers. Eventually, the cords thicken, lengthen, and tighten, and they pull one or more fingers into a permanently bent position. This makes it increasingly difficult to straighten the fingers and to do daily tasks such as writing, cooking, and dressing.

Thankfully, this condition—called Dupuytren disease or Dupuytren contracture—is treatable, something that many people are unaware of.

Help is Available

“It’s really surprising that even today, many people with this condition think there is nothing that can be done, so they don’t try to get help,” says Dr. Benjamin B. Garner, Orthopedic Surgeon at East Falls Orthopaedics.

Dupuytren disease is a genetic condition; people of Northern European descent are at higher risk.   In fact, one of the earliest names for Dupuytren disease was “Viking hand disease.” Since it is genetic, there is no cure; but treatments are available and can be effective.

Dr. Garner, who completed the Hand and Upper Extremity Fellowship at Hamot Medical Center, has helped many Dupuytren patients over the years. He has seen patients at all stages of progression and uses a standard method to determine whether they need treatment—the “tabletop test.”

“Basically, I have the patient place their hand, palm down, on a tabletop. If they can flatten their hand completely without significant pain or problems, then there’s no reason to do anything yet,” explains Dr. Garner. “If they can’t, it’s time to do something. The earlier they seek treatment, generally the easier the recovery and the better the outcome. The best outcomes happen when you do something before the fingers are stuck in a flexed position.”

Treatment Option 1:  Injection

In the early stages of Dupuytren disease, the nodules and cords can be injected with a bioengineered enzyme to disrupt the abnormal collagen, and the fingers can be manually straightened two days later.

“I can do the injection and straightening in my office. The injection kind of ‘chews up’ the nodules,” says Dr. Garner. “A couple days later, the patient comes back to the office. I numb the hand, and I manipulate and stretch  the finger to release the contracture. This treatment has been available since 2012 and is very effective.”

Treatment Option 2:  Surgery

For more severe cases, where the finger or fingers are bent into the palm, surgery is sometimes required.

As Dr. Garner explains, “It’s an outpatient procedure, but it is still surgery. It has to happen in the OR and requires an incision in the hand to surgically remove the nodules and cords. Even so, if surgery is done before the condition is severe, then outcomes are often good. There’s less scarring, the hand heals faster, and the patient regains more range of motion if the condition is treated early vs. late. Once the skin heals, there are no restrictions and moving the hand is encouraged for recovery.

“Most people see significant improvement with either treatment—injection or surgery. I’ve had a patient or two try the injection, but when they weren’t satisfied with the results, they opted for surgery.”

The biggest difference between treating Dupuytren disease with an injection vs. surgery is rate of recurrence. Since there is no “cure” for Dupuytren, the condition can sometimes return after treatment, which happens somewhat more often with the injection.

“This is most likely because, with the injection, I’m not physically removing all the abnormal tissue, just disrupting it. Some of that tissue is still there and can regenerate. With surgery, when all the abnormal tissue in a specific ray is found and removed, it is uncommon for it to come back in that specific finger. But it can still develop in the other fingers,” Dr. Garner says. 

Since those with a genetic predisposition for Dupuytren disease may not know they have it, and because the condition can manifest at any age, it is important to see a doctor as soon as a nodule is felt in the hand. Monitoring and early treatment can prevent severe, debilitating hand disfigurement and preserve range of motion and independence.

To schedule an evaluation with Dr. Garner, visit East Falls Orthopaedics or call (208) 535-4580.