Dupuytren's Disease

What is Dupuytren’s disease?

Dupuytren’s disease is a thickening of the fibrous tissue (fascia) just under the skin of the palm. Over time, firm nodules and cords develop, which can progressively pull one or more fingers into a bent position that cannot be straightened. It most commonly affects the ring and little fingers.

It’s more common in men, in people of northern European descent, and tends to run in families. The cause isn’t fully understood. The disease progresses slowly over years, and not every patient ends up needing treatment.

Symptoms

• A firm nodule in the palm, often first noticed as a small lump
• A cord of tissue developing under the skin, extending into the finger
• Progressive inability to fully straighten the finger
• Difficulty putting the hand flat on a table (the “tabletop test”)
• Problems with everyday tasks - putting the hand in a pocket, shaking hands, washing the face

Dupuytren’s disease is usually not painful.

Diagnosis

Dupuytren’s is diagnosed from the history and examination. Imaging and other investigations are not required.

Non-surgical treatment

For mild, non-progressive disease without significant finger contracture, observation is reasonable. No treatment is needed simply because a nodule is present - treatment is driven by functional impact, not appearance.

Surgical treatment - fasciectomy

When the contracture is significant enough to affect function - typically when you can no longer place the hand flat on a table, or when the finger is pulled down by more than 30 degrees at the knuckle - surgery is offered.

The procedure is a limited fasciectomy: the diseased cord of tissue is surgically removed through an incision in the palm and finger, releasing the contracture and restoring finger extension. This is the most widely used surgical treatment for Dupuytren’s and has the lowest recurrence rate of the available options.

• Performed at Townsville Day Surgery or Mater Hospital Pimlico
• Usually under a regional nerve block (the arm numbed from the shoulder down) with light sedation
• Takes around 45-60 minutes depending on the extent of disease
• You go home the same day

Recovery

Recovery from Dupuytren’s surgery is longer than most other hand operations because of the extent of the dissection and the importance of regaining finger movement:

• Day of surgery - home with the hand bandaged and a small splint
• Week 1 - first hand therapy appointment; early finger movement is essential to avoid stiffness
• Weeks 2-6 - ongoing hand therapy, custom splinting (often a night splint for several months), stitches out around 10-14 days
• Weeks 6-12 - returning to most normal activities; desk work within 1-2 weeks, manual work 4-8 weeks
• Months 3-6 - final result becomes apparent

Hand therapy is central to recovery and is available through NQ Hand Care Clinic at the same North Ward location.

Risks

• Stiffness - the most common issue after Dupuytren’s surgery; managed with hand therapy and splinting
• Nerve or artery injury - the diseased tissue often wraps closely around the digital nerves and arteries, which makes this surgery technically demanding. Injury is uncommon but not negligible
• Recurrence - Dupuytren’s can recur over years, and occasionally in a different part of the hand
• Infection - rare
• Wound healing problems - occasional, particularly in the palm
• Complex regional pain syndrome - rare but recognised