I am a 60 year old male rancher and have developed firm nodules and thick cords in my hand. It is now difficult to straighten my fingers? Can anything be done for this condition? JM, Joliet

Dear JM,

I suspect that you have developed a hand condition known as "Dupuytrens Disease", named after the famous 18th century French physician Baron Von Dupuytren.

This condition is more common in males between the ages of 40 and 70, particularly with Northern European ancestry. The disorder is due to a spontaneous thickening of the tissue between the skin and the underlying tendons, nerves, and arteries. This specialized tissue is known as fascia and it acts to stabilize the skin of the palm and digits during grip activities.

The cause of Dupuytrens disease, other than a genetic predisposition, is largely unknown.

Individuals often notice painless firm nodules along the small finger side of the palm that gradually enlarge and coalesce to form thick cords. The cords can eventually extend into the fingers and cause them to flex into the palm making activities such as shaking hands, putting your hand in your pocket or glove, or even firm grip difficult. Occasionally, patients can experience brief periods of discomfort when the nodules first appear or can develop painful digital clicking and locking because of narrowing around the flexor tendons.

In the early stages, observation is generally recommended although a few centers in Europe have reported success with low dose radiation therapy. If the nodules are very painful, cortisone injections can be helpful.

In more advanced cases with cord formation and digital contractures, a variety of treatment options exist. In milder degrees of contracture, a percutaneous needle fasciotomy (PNF), where the cord is divided at multiple levels with a needle or small knife blade, can be quite successful in restoring finger extension without a lengthy recovery time.

Another option for milder cases is an injectable medication that is now available that will dissolve the cord tissue. The patient undergoes the injection on one day and then the cord tissue is physically ruptured the following day in the office.

In cases with more severe contractures, formal removal of the cord tissue along with soft tissue flaps and skin grafts still seems to give the best long term results for most patients. The surgical procedures offered today often use smaller incisions and can be done in an outpatient surgical center.

If you believe you may be suffering from this disease, a consultation with a hand surgeon can help you decide the best treatment options.

Good Luck,
Ralph M. Costanzo, MD

Dr. Costanzo is a hand surgeon and partner at Ortho Montana in Billings, Montana. He has a special interest in Dupuytrens disease and is currently part of an international investigators group into this particular hand disorder.