Founded by Dr. Raven in 2008, the mission of the Dupuytren’s Center of California is to provide education and comprehensive treatment options to people with Dupuytren’s Disease.
Understanding Dupuytren’s Disease
Dupuytren’s disease is an abnormal thickening of the fascia, the tissue just beneath the skin of the palm. It often starts with firm lumps in the palm. Gradually, these lumps may grow into firm cords stretching from the palm into the fingers, potentially causing the fingers to bend into the palm. While the cause of Dupuytren’s disease is unknown, it's more common in men over age 40 and in people of Northern European descent.
Symptoms of Dupuytren’s disease usually include a small lump or series of lumps and pits within the palm, which are generally firm and adherent to the skin. Over time, a cord may develop, extending from the palm into one or more fingers, with the ring and little fingers most commonly affected. The disease may first be noticed due to difficulty placing the hand flat on an even surface, such as a tabletop. As the fingers are drawn into the palm, you may notice increasing difficulty with activities such as washing, wearing gloves, shaking hands, and putting hands into pockets.
Despite the potentially alarming presentation, Dupuytren’s disease and similar conditions like Palmar Fibromatosis are typically not painful. If you're experiencing hand pain associated with palmar nodules or thickening of the palmar fascia, it may be due to an underlying condition such as a trigger finger. Dr. Raven is experienced in differentiating between these conditions and will guide you towards the appropriate treatment.
Dupuytren’s Disease vs. Palmar Fibromatosis
Not all lumps or thickenings in the hand are indicative of Dupuytren's disease. Another condition called non-Dupuytren's palmar fibromatosis also presents with similar symptoms. Unlike Dupuytren's Disease, palmar fibromatosis is not typically associated with a family history and exhibits more ethnic and gender diversity. It is often non-progressive and may even regress over time. Non-genetic factors like hand or wrist trauma, prior hand surgery, and systemic conditions like diabetes or excessive alcohol consumption may contribute to its development.
Understanding Dupuytren’s Diathesis
Another important aspect in the spectrum of Dupuytren's disease is Dupuytren’s Diathesis. The term 'diathesis' is a medical term meaning tendency toward a condition. When applied to Dupuytren's, it describes a tendency towards a more aggressive form of the disease. This translates to faster progression and more recurrence problems. The hallmark of Dupuytren’s diathesis is having several of the following risk factors:
- Early age of onset
- Involvement of more fingers
- Bilateral occurrences (both hands affected)
- A family history of Dupuytren’s disease
- Knuckle pads
- Ledderhose disease (involving the feet)
- Peyronie’s disease (penile fibromatosis)
- Frozen shoulder
This more aggressive biology also implies that people with Dupuytren’s diathesis are more likely to have ancestors with Dupuytren’s and are more likely to pass Dupuytren’s on to their children than people with only Dupuytren’s. It highlights the importance of accurate diagnosis and tailored treatment strategies in these cases.
It is crucial to understand that the presence of a lump in the palm doesn't necessarily mean that treatment is required or that the disease will progress. Treatment is indicated if and when a contracture develops that causes a functional deficit. In other cases, observation may be the best approach.
Patients with a advanced contractures may be candidates for various procedures.
- Percutaneous Needle Aponeurotomy (NA)
- Collagenase (XIAFLEX®) injections
- Surgical Fasciectomy
Dr. Raven has extensive clinical and surgical experience in the treatment options currently available for Dupuytren’s Disease: XIAFLEX® injection therapy, needle aponeurotomy, and surgical fasciectomy. Prior to March 1, 2010, Dr. Raven was the only hand surgeon in California experienced in all three methods of treating Dupuytren’s disease. As a principal investigator during Phase II clinical trials, Dr. Raven gained early clinical experience using XIAFLEX®, treating 31 patients with the drug before it was commercially available. The method most appropriate for your condition will be chosen based on the stage of the disease and the joints involved, with the aim to improve finger position and thereby hand function.
Specific treatment considerations:
- The presence of a lump in the palm does not mean that treatment is required or that the disease will progress.
- Correction of finger position is best accomplished with milder contractures and contractures that affect the base of the finger. Complete correction sometimes cannot be attained, especially of the middle and end joints in the finger.
- Skin grafts are sometimes required to cover open areas in the fingers if the skin is deficient.
- The nerves that provide feeling to the fingertips are often intertwined with the cords.
- Severe contractures may need to be treated with an external apparatus, such as the Digit Widget, which is used to slowly correct the deformity over a period of 6 to 12 weeks.
- Splinting and hand therapy are often required after surgery in order to maximize and maintain the improvement in finger position and function.