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New Treatments for Dupuytren's Disease

 Dupuytren's disease is a common condition that many people have probably never heard of. The disease causes knots of tissue to form under the skin of the hand, slowly pulling one or more fingers into a bent position. The fingers then cannot be straightened back out, leaving the hand deformed. "About five percent of people in the United States at some point will have some element of Dupuytren's Disease," says Shaun Mendenhall, MD, a hand and wrist surgeon with University of Utah Health. "It could happen to anybody of almost any age."

A genetic component can predict who is more likely to suffer from Dupuytren's disease. The condition is largely seen in men of Northern European descent. It typically starts developing between the ages of 40 and 60. But the development of the disease is different from patient to patient. "Somebody could get a little nodule and it may never progress into anything else," Mendenhall says. "Some people are rapid progressors, and this could become debilitating within a short period of time."

The first signs of Dupuytren's disease are small lumps, bumps, or pits in the palm of the hand around the base of the ring and pinky fingers. These are caused by abnormal growth and contraction within the fascial layers of the hand. Abnormal fibrous tissue builds up, begins to shorten, and can form cords that eventually cause the fingers to bend into the palm. "Obviously, from a functional standpoint, that could be devastating," Mendenhall says. "You can't put your hand in your pocket or into a glove, or you can't get your hand around something large like a soda can. Sometimes you even poke yourself in the face when you try to wash it."

Surgery used to be the only option for patients in the advanced stages of Dupuytren's, but that has recently changed. Now, a medication can be injected into the hands that breaks up the collagen and allows the fingers to be straightened. "It ruptures those cords, and it enables them to have straight fingers again," Mendenhall says. "This is one of the biggest medical advancements for the condition since it was first described by Guillaume Dupuytren in 1834."

In some cases, surgery may still be necessary, with two options depending on the severity of the disease. The less invasive surgery involves using a needle to break up the tissues causing the fingers to bend. The other option involves lifting the skin of the palm, then removing all the abnormal fibrotic tissue before replacing the skin. "Patients tend to do quite well after surgery, but it is a significant surgery that requires splinting and hand therapy afterwards," Mendenhall says.

Maintaining hand function is the goal when it comes to the treatment of Dupuytren's disease. This is best achieved when the condition is discovered early, when lumps or pits are starting to form. "Make an appointment with a hand specialist," Mendenhall says. "Get evaluated so you know how bad the situation is. Then your doctor can work with you to get the function back in the hand."