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QUESTION: Over the last 4-5 years, I have been increasingly handicapped by thick bands of tissue that have grown in my palm, which have eventually forced my ring and small fingers into a curled position. At this point, I cannot forcefully straighten out my fingers with my other hand. I find it extremely difficult to drive, put on gloves, and grasp objects like the telephone. What can be done about this?

ANSWER: Dupuytren's disease was first described by Baron Guilaume Dupuytren in France in 1833. This disease causes a contracture of the fibers of the palm that lie between the skin and the tendons that help flex the fingers. This contracture mostly occurs at the level of the knuckle joint, but can occur further out on the finger(s). Other areas that may be affected are the groin and the soles of the feet.

The exact origin of Dupuytren's disease is unknown. Although some physicians have tried to attribute this disease to a hereditary genetic pattern, this has never been proven. It is true that many patients who have Dupuytren's disease have other affected members within their families. Although Dupuytren's disease has been linked to epilepsy, alcoholism, diabetes and trauma, most patients who have the disease are not afflicted with any of the above disorder.

Generally, the first thing noted by a patient is a small nodule in the palm or at the base of the finger. As the disease progresses, a cord develops in line with the finger, spreading from the palpable nodule. Eventually, the finger is forced into flexion and patients gradually lose function of their involved hand. The fingers which are most commonly affected are the ring and small fingers, however, Dupuytren's disease can occur in all digits including the thumb.

Patients who are most likely to be affected by Dupuytren's disease are between 40 and 60 years old, and the ratio of males afflicted to females is approximately 6 to 1. Over half of patients have involvement on either the groin or the foot, as previously described. Although this disease slowly progresses, it may have periods of both temporary arrest and very rapid progression; these periods of significant progression are often accompanied by an aching pain. Although anti-inflammatory drugs can sometimes aid in reducing the pain from Dupuytren's disease, there is no non-surgical treatment at this time.

Surgery is performed for relief of the bothersome contracture of the fingers. Local excision of the nodule is not recommended because of the high percentage of rapid recurrence. Complete fasciectomy releases all finger joint contractures and completely excises both the nodule and its accompanying band. All diseased fascia must be removed to prevent recurrence of the joint contractures. This requires meticulous dissection under magnification to avoid damage to the tiny critical nerves and arteries which run on the palmar surface of the hand. After surgery, the patient's fingers are usually splinted in extension and the skin is allowed to heal under a small degree of tension. Motion exercises are started after the acute surgical pain has subsided and are directed towards maintaining extension of the newly freed finger joints. Most patients are highly satisfied with surgery, even if a small degree of contracture remains.

Q & A: DUPUYTREN'S DISEASE