Dupuytren’s contracture

This is a thickening of the fascia on the palm of the hand or the fingers. It may present as a nodule or a cord. It is often not painful. It can be present in both hands. There are many reasons why this may occur.

There may be more than one cord in the hand. The nodule or the cord in itself is not problematic but the disease can progress to cause permanent bending of the fingers. This bending can progress. Once this occurs it is best dealt with sooner rather than later. Once the small joints in the hand bend close to 90 degrees, they can develop irreversible contracture that may not be easy to correct even with surgery.

In certain situations, it may be possible to use a specific enzyme (collagenase) to try and dissolve this thickening. This is only possible for palmar Dupuytren’s. Unfortunately, the drug has been withdrawn from the market for commercial reasons and is no longer available but hopefully it may be available in the future.  Mr Mohan may still be able to do a non-operative treatment in the form of a needle fasciectomy if there is a clear cord in the palm. 

Needle fasciotomy is carried out under local anaesthetic. This involves passing a needle repetitively through the cord at one particular point and then forcing the bend finger to straighten. This would tear the cord and achieve correction of the bending.

Surgical excision requires a general anaesthetic. It involves removing the whole cord to achieve correction of the bending. If the deformity is severe, then skin grafting may be required.