DUPUYTREN'S DISEASE

This disorder isn't really a disease for it is not widespread, usually only affecting the palms of the hand and fingers. Fibre thickening develops in the layer between skin and tendon/bone/joint. The fibre tends to pull the fingers into a bent posture.

Treatment to correct the bent posture is by surgery, for other methods are not successful.

SYMPTOMS.

Areas of fibre and nodule formation are noticed in the palms. The fingers are drawn into a flexed posture, which progressively causes difficulty doing tasks.

Usually the ring and little fingers are affected first but the others can be affected too.

SIGNS

The fibre nodules and cords can be seen or felt. The skin may be drawn inwards to form a pit. Depending on severity, there are finger angular deformities.

DIAGNOSIS

This is based on finding the typical features of Dupuytren's and excluding other causes of joint deformity, such as, past dislocation or fracture and arthritis.

COLLAGENASE INJECTION TREATMENT

A recent development is that some cases of the Dupuytren's disorder can be treated by an injection of the enzyme collagenase (Xiapex), which causes breakdown of fibre tissue.Mr Savage is licensed and has been trained to use Xiapex/collagenase: and has experience of using the drug

SURGERY

The principle of surgery is to remove the thickened and shortened fibre cords and to lengthen the shortened skin. The aim is to straighten the finger and retain mobility.

A range of operations can be used, but to generalise, smaller operations are best for modest deformities and bigger operations are best for severe deformities.

A problem with surgery is that recurrence can occur some years later. Certain treatments, such as skin grafting, are more likely to prevent recurrence and these are applied where the disease is moderate or severe.

After surgery, pain is controlled by drugs or insertion of local anaesthetic into the operation site. Elevation of the hand prevents excessive swelling. Movement and light use soon after surgery improves recovery.

Physiotherapy helps to increase movement and strength and, in most cases, a night splint is used to reduce early recurrence by scar contracture.

This is the current term for a fracture on one side of the wrist joint, previously called Colles fracture



 

 

 

 

 

 

St Josephs Hospital tel: 01633 820318 Royal Gwent Hospital tel: 01633 234161