I’ve got vision and the rest of the world’s wearing bifocals.
Paul Newman as Butch Cassidy in “Butch Cassidy and the Sundance Kid”
One of the more interesting problems a hand surgeon encounters is a rather unusual condition know as Dupuytren’s disease. This is a condition where the normal tissue in the palm of your hand becomes thicker and can sometimes progress and cause the fingers to pull down and contract. Dupuytren’s disease usually starts as a nodule in the palm of the hand. This can occur at the base of any finger, including the thumb. In some cases the nodule can be painful and tender, but generally the pain and tenderness go away and the patient is left with a small painless knot in their hand.
Most patients are usually first seen by their primary care physicians for this problem. Most of the time it’s not hard to diagnose the problem, but sometimes the nodule can be confused for a cyst in the hand, and cysts do occur in the same area. However if you’re carefully examined a physician can usually tell the difference between a cyst and a dupuytren’s nodule. Patients are usually sent to a hand surgeon for evaluation and recommendations for treatment.
There is no single cause for Dupuytren’s disease. Some patients will have family members who have had the problem, but the majority of the time patients don’t know or can’t remember any relatives who had the problem. The disease does seem to be more closely associated with certain ethnic groups, although Dupuytrens’ has been seen in patients of all races and cultures. The most common association is with people of Northern European descent, so much so that one of the names for Dupuytren’s disease is “Viking Disease”. Trauma, either acute or repetitive, does not cause Dupuytren’s disease. So most of the time the nodules just appear, seemingly out of nowhere. The disease occurs in both men and women, but is much more common in men, probably by a ratio of 2:1 or higher.
If you have a nodule, there is a pretty decent chance that a contracture, or pulling down of the finger, will never occur. The best estimate is that only 50% of people who develop a nodule, or bump, will ever go on to have a contracture that will bother them or require treatment. There is no treatment that can affect the progression of the disease. No medicine, diet, exercise or anything else will have any affect at all on this process. The one thing that can make it worse is to operate on a nodule before it causes a contracture, since that can sometimes cause a progression of the disease and further problems. I’ll talk about that more in my next post, when I’ll talk about the treatment of the disease.
Some factors do raise a red flag and indicate that a patient may develop a contracture that will cause problems and require treatment. The most important is probably a strong family history of the disease. If Dad or an uncle had a bad contracture, then the odds are pretty good that if you develop the disease then you will have a significant contracture as well. Another bad sign would be if you have similar nodules elsewhere in your body. The most common area is the bottom of the feet. Also, some patients all develop tender areas on top of their fingers called “knuckle pads”, and if you have these that can be a sign that the disease may progress. The third factor would be developing the problems at a younger age, younger in this case being below the age of 50.
My next blog will discuss the treatment of Dupuytren’s disease. There have been some exciting advances in treatment and some new, non-surgical treatments are available that I will discuss in detail.