HAND/WRIST
Dupuytren disease (DD) or as it is sometimes labeled the Viking disease, is an abnormal accumulation of tissue beneath the skin in the palm and fingers. DD was given this colorful name because early accounts of the condition were localized to Nordic locations. This condition has been recognized for centuries, with the first description by Plater of Basle in 1614 and later more famously by Baron Guillaume Dupuytren in 1831. There is good evidence of a northern European migration of DD, however there are cases of DD around the world where its occurrence would not be expected based on migration alone. Bottom line, Vikings had DD, but not everyone with DD is a Viking.
Who gets it and why?
The cause of DD is unknown. There are genetic and environmental factors that contribute to the prevalence and severity of the condition. DD is more common in men, with a male-to-female ratio of nearly 6:1, and is often diagnosed in individuals over the age of 40.
How do you know you might have it?
DD progresses in 3 phases and these phases do not have a set time, meaning, an individual could be in phase 1 for 5 years, and another person 6 months. The first sign is a lump, which may be confused for a callus, except it is located in the middle of the palm. These lumps or nodules are firm and frequently not painful. Next thick cords of tissue develop under the skin in the palm and progress into the fingers. The small and ring fingers are commonly involved. In the final phase, the cords cause the fingers to bend into the palm, like pulling the reigns of a horse. This bending or contracture limits the ability to straighten the finger but has no effect on the ability to grip objects.
What is the treatment?
There are treatments for DD, but no cure. Treatment options are focused on improving function. In mild cases a nodule and or cord may be present but there is no limitation in daily activities. In these cases observation is appropriate. In more severe cases there are options to help straighten the finger. These options include: Needle aponeurotomy, an office procedure to weaken the DD cord with multiple needle punctures under local anesthesia. Collagenase injection in the office, an enzyme injection into the cord to help straighten the finger. Surgical release in the operating room. Treatment is guided by DD severity and patient preference. Hand therapy plays a pivotal role after treatment to help maintain finger function.
To learn more click here. And here - you can even donate to the Dupuytren Research Group!
