Dupuytren’s disease is a progressive disease which causes progressive and irreducible flexion of one or more fingers of the hand. This chronic contracture preferentially affects the fourth and fifth fingers. The attack is disabling in its severe form (when the finger is very folded in the palm), but generally painless. The origin of this disease, named after Baron Guillaume de Dupuytren who described it in 1831, is unknown to this day. Surgery may be necessary to restore the affected finger to its ability to move, but recurrences are common.

Dupuytren’s disease is characterized by the thickening of the tissue between the skin and the tendons on the palm of the hand at the level of the fingers (the palmar fascia). As it evolves (often irregularly but inevitably), it “curls up” the finger or fingers towards the palm and prevents their extension, but not their flexion. The progressive retraction of the tissues is recognizable to the eye by the formation of “cords”.

It is frequently around the age of 50 that the first symptoms of Dupuytren’s disease appear. It should be noted that women tend to develop the disease later than men. Be that as it may, the earlier the attack, the more important it will become.

All the fingers of the hand can be affected, but in 75% of cases the involvement begins with the fourth and fifth fingers. (1) It is much rarer, but Dupuytren’s disease can affect the backs of the fingers, the soles of the feet (Ledderhose disease) and the male sex (Peyronie’s disease).

The origin of Dupuytren’s disease is still unknown to this day. It would be partly (if not totally) of genetic origin, several members of a family being often affected.

The consumption of alcohol and tobacco is recognized as a risk factor, just as it is observed that several diseases are sometimes associated with Dupuytren’s disease, such as epilepsy and diabetes. A controversy stirs the medical world over exposure to biomechanical work as a risk factor for Dupuytren’s disease. Indeed, scientific studies carried out among manual workers indicate an association between exposure to vibrations and Dupuytren’s disease, but manual activities are not recognized – to this day – as a cause or a risk factor. (2) (3)

The causes of the disease being unknown, no treatment exists to date, other than surgery. Indeed, when the retraction prevents the complete extension of one or more fingers, an operation is then considered. It is intended to restore range of motion to the affected finger and to limit the risk of spread to other fingers. A simple test is to be able to lay your hand completely flat on a flat surface. The type of intervention depends on the stage of the disease.

• Section of the bridles (aponeurotomy): this is performed under local anesthesia, but presents a risk of injury to vessels, nerves and tendons.
• Removal of the bridles (aponevrectomy): the operation lasts between 30 minutes and 2 hours. In severe forms, the ablation is accompanied by skin grafting. This “heavier” surgical procedure has the advantage of limiting the risk of recurrence, but the disadvantage of leaving significant aesthetic sequelae.

As the disease is progressive and surgery does not treat its causes, the risk of recurrence is high, especially in the case of an aponeurotomy. The recidivism rate varies between 41% and 66% depending on the sources. (1) But it is possible to repeat several interventions during the disease.

After the operation, the patient must wear an orthosis for several weeks, a device that keeps the operated finger in extension. It is developed by an occupational therapist. A rehabilitation of the fingers is then prescribed in order to restore its range of motion to the finger. The operation presents the risk, in 3% of cases, of revealing trophic disorders (poor vascularization) or algodystrophy. (IFCM)