What is dupuytren's disease?

In Dupuytren's (say "duh-pwee-TRAHNZ") disease, tissue under the skin in the palm of your hand, called the palmar fascia, gets thicker and shorter. This can cause your fingers to bend in toward your palm. It most often affects the ring and small fingers, usually of both hands.

The disease may only involve the palm and never affect your fingers. If it gets worse, it may be hard to use your hands.

Dupuytren's disease has three general phases:

• In the early phase, you may see or feel a small lump in the palm of your hand, usually near where your ring finger and small finger meet.
• In the active phase, you may have dimpling on the skin of your palm. Long, ropey cords or bands form in the fascia. You may be able to see or feel them.
• In the advanced phase, a fibrous cord may form in the fascia that pulls your fingers toward your palm. This is called Dupuytren's contracture. Over time, you won't be able to straighten your fingers or flatten your hand on a table. It may be hard or impossible to do things like put on gloves, wash your hands, or pick up things.

In most cases, Dupuytren's doesn't cause pain. You may not even notice it until you develop a contracture.

The disease usually gets worse slowly. In many people, it never causes major problems.

A physical exam and medical history will usually give enough information for a doctor to decide if you have Dupuytren's disease. Your doctor will look for skin changes on your palm and feel for any knots or a cord. They may also watch you move your hand, wrist, and fingers.

The goal of treatment for Dupuytren's is to keep your hand working as well as it can. You may not need treatment unless you have a contracture. Treatment options include:

• Collagenase injection. A medicine called collagenase (such as Xiaflex) may be injected into the tight cord to try to dissolve some of the tissue. This may help reduce the contracture and improve your range of motion.
• Needle aponeurotomy (say "ap-uh-noo-RAH-tuh-mee"). A needle is used to make small holes in the tight cords in the palm. Then the fingers are extended to separate the cords.
• Surgery to remove or separate the affected tissue in the palm. A skin graft may be done to cover open areas in the palm.

• Follow your doctor's advice for physical or occupational therapy and exercises to put your fingers and hand through a range of motion.
• Two times a day, massage your hand and gently stretch the fingers back. This can get rid of tightness and help keep your fingers flexible.
• Try to avoid curling your hand tightly. For example, use utensils and tools that have larger hand grips.