Other popular names
The Curse of the McCrimmonds
Who does it affect?
Usually males over the age of 40 years, occasionally females.
Why does it happen?
There are a number of causal reasons associated with developing Dupuytren's disease. These include amongst others: genetic (inherited), diabetes, excess alcohol intake, epilepsy and/or its treatment. In the vast majority of people we do not know why they develop the disease, but is probably inherited to some extent.
Thickening and cord like structures develop gradually in the palm and extend into the fingers causing the fingers to roll up into the palm. In the initial stages the nodules can be tender but this usually settles.
The disease is usually very easy to diagnose and has a very characteristic appearance. A simple test to try and evaluate the severity of the disease is the "table top test". The patient is asked to place the hand flat on the table. If they are unable to do so then it is likely that disease may need surgery in the future.
Occasionally night splinting by a therapist will allow the fingers to straighten. However these are not well-tolerated long term.
Surgery is performed usually as a day case procedure usually under general or regional anaesthetic and takes between 30 and 60 minutes.
The surgery is performed through a zigzag type incision in the palm and along the finger. The skin flaps are elevated and great care is taken not to injure nerves and blood vessels to the finger. The Dupuytren's disease is removed. Occasionally in more advanced cases a skin graft needs to be placed over the wound. The skin is taken from the forearm. The tourniquet is then released and any bleeding controlled. Local anaesthetic is infiltrated into the skin. The skin is sutured and a bulky dressing is applied with for immobilisation
The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. The dressing should be removed soon after your operation. The wound is cleaned and redressed with a simple dressing. The skin stitches are removed between 10 and 14 days post op. The therapist will apply a resting night-time splint that should be used at night for 6 months.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving: The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.
Return to work: Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction).
- Recurrence: the disease will always recur, however, most people have a long lasting result that they are happy with.
- Failure to completely straighten the finger (particularly after the 2nd and 3rd time surgery or advanced disease)
- Injury to the blood vessels and nerves to the finger (very much less than 1%) may leave one side of the finger numb. If this occurs the wound should be explored and if injured, the nerve repaired.
- The skin graft, if used, not healing.