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Dupuytren's Disease

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Introduction

Dupuytren’s disease causes an abnormal thickening of the tissues located underneath the skin in the palm of the hand. As the tissue thickens it can form lumps and strong cords. The abnormal growth causes the fingers to bend in towards the palm of the hand.  Severe symptoms can cause contractures and loss of hand function. Dupuytren’s disease generally progresses slowly, but progression is unpredictable.
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Anatomy

The palm of your hand contains ligaments and tendons.  Ligaments are strong bands of tissues that connect your bones together.  Tendons attach muscles to bone.  The tendons in the palm of your hand flex or bend your fingers inward.  Your ligaments and tendons are covered and kept in place by the palmar fascia, a thin sheet of connective tissue.  The palmar fascia is located just beneath your skin.
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Causes

The cause of Dupuytren’s disease is unknown.  It may be associated with abnormal biochemical processes in the palmar fascia.  It is more common in people of Northern European descent.  It occurs more frequently in men than in women.  Dupuytren’s disease is rare among young people and more common in people over 40 years old.  If it occurs in young people, the condition tends to be very severe and quickly progressing.
 
Smoking and drinking alcohol increase the risk of Dupuytren’s disease.  Certain medical conditions are associated with an increased risk of Dupuytren’s disease.  Such conditions include diabetes, thyroid problems, epilepsy, pulmonary tuberculosis, and liver disease.
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Symptoms

The onset of Dupuytren’s disease is very slow.  Both hands may be affected but usually one hand is more affected than the other.  You may notice a small tender lump in the palm of your hand.  The tenderness will go away as Dupuytren’s disease typically is not painful.  Over time, tough cords may form beneath your skin.  The thickened tissue may cause your fingers to bend inward toward your palm.  Your ring finger and little finger are affected most often.  You may have difficulty straightening your fingers. 
 
The progression of Dupuytren’s disease is unpredictable.  For some, the condition may consist of a lump or thickening of the tissue.  Other people may experience severe symptoms, including contractures and loss of hand function.
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Diagnosis

Your doctor can diagnose Dupuytren’s disease by examining your hand.  You should tell your doctor about any symptoms and if they restrict the use of your hand.  Your doctor will look at and feel the skin on the palm of your hand for thickened tissue or nodules.  Your doctor will observe your finger positioning and test the movement of your finger joints.  You may be asked to perform the Table Top Test, in which you will attempt to place your open hand on a surface and flatten your palm and fingers out as far as you can.  This will be difficult in the presence of finger contractures.
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Treatment

There is no way to stop the progression of Dupuytren’s disease.  Your doctor will monitor the progress of your disease.  Injections may help relieve the pain in a lump that has formed early in the disease process.  Surgery is recommended if the fingers become flexed enough to interfere with the functional use of your hand.
 
Injectable enzymes to dissolve the diseased tissue were FDA approved in 2010. The product is called Xiaflex. Studies and ongoing use of the enzyme have shown success in treating finger contractures caused by Dupuytrens Disease.
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Surgery

The goal of surgery is to increase the movement of your fingers and restore their correct positions to improve hand functioning.  There are several different options for this.  Your surgeon may simply divide the thickened bands in a procedure called fasciotomy.  Your surgeon may remove the sheet of diseased palmar fascia in a procedure called fasciectomy.  In some cases, a skin graft may be necessary.
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Recovery

Following surgery, you will participate in rehabilitation with a hand therapist who will instruct you in strengthening and stretching exercises.  You may receive therapy treatments to reduce swelling and ease pain.  Your hand therapist will provide you with a splint to position your hand and promote healing.
 
Surgery is not always a permanent solution for Dupuytren’s Disease.  The condition tends to gradually recur over time. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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Dr. Reznick did major surgery on my right hand (carpal tunnel and 3 trigger fingers). Prior to the surgery, I could not hold a pen or write my name legibly. I was in constant pain. After the surgery, while the stitches were still in and the brace still in place, I had more flexibility in my fingers than I had before the surgery. I am six weeks out from the surgery and I continue to progress. I have more functionality and strength in my hand than I have had in the last year. I can't even see the scars on my hand. Dr. Reznick not only did a spectacular job of restoring the use of my hand, but she is a very likable person. Her staff is friendly and professional. I cannot say enough good things about this experience!

Nancy L.

via md.com

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Les D.

via healthgrades.com

Amazing visit. I can't remember the last time I spent quality time with a doctor. She explained everything to me on why I was having trigger finger issues. I have been dealing with this for some time. She nailed it on the first visit ‘cause she talks to you and listens! If you need a hand doctor you will be happy she is the one.

Anonymous

via healthgrades.com

Dr. Reznick is one of the most professional, sensitive and caring physicians I have visited. She is a teacher--patient and informative, and she made sure I understood just exactly what was necessary for my particular problems. She took care of both my left and right carpal tunnel surgeries, and I couldn't have asked for a better recovery. Everything went just as planned. She is my ‘go to’ hand doctor!

Anonymous

healthgrades.com

When I was having problems with my wrist, she guided me through every step, and always made sure I was comfortable with what she was doing. Very straightforward and trustworthy. I never doubted what she was doing and she always wants to try every technique before doing surgery to try to make you better.

Shannon C.

healthgrades.com

I recently rode 900 miles on a vibrating Harley-Davidson and did not have a single tingle in either of my hands. You do great work. Thanks for helping me.

Ed G.

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Randall A.

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Kevin M.

Dr. Lisa Reznick has performed carpal tunnel surgery on both hands and has removed my basal joint from my right hand. All of my surgeries have been successful, and I now have complete use of both hands and my right thumb, which I credit to a great surgeon, good therapy, and a genuine concern for patients.

Robert

My hand is in perfect working order because of your expertise. I appreciate your genuine concern for my healing. Through the myriad of maladies my husband experienced, I became acquainted with many doctors. None even approached your level of patient care.

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Dr. Reznick performed surgery on my hand for ‘trigger finger’ and did a wonderful job. I’ll definitely user her again if the need ever presents itself again.

Don L.

Dr. Reznick is very to the point and no nonsense. She tells you what options there are in your treatment and advises you accordingly. I had hand surgery four years ago and it was a complete success. I actually went back to work one week early. I have recommended Dr. Reznick to many friends and associates. Frankly, I won’t go to anyone else when it comes to muscles or bones. I have complete faith in her.

J. Schully

via vitals.com

Dr. Reznick did major surgery on my right hand (carpal tunnel and 3 trigger fingers). Prior to the surgery, I could not hold a pen or write my name legibly. I was in constant pain. [Now] I have more functionality and strength in my hand than I have had in the last year. I can't even see the scars on my hand. Dr. Reznick not only did a spectacular job of restoring the use of my hand, but she is a very likable person. Her staff is friendly and professional. I cannot say enough good things about this experience!

~ Nancy L. via md.com

Lisa R. Reznick MD, PA

Board Certified Orthopedic and Hand Surgeon

4100 Fairway Court, Suite 120
Carrollton, TX 75010
Phone: (972) 395-9000
Fax: (972) 395-9002

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In Carrollton, TX, board-certified orthopedic surgeon Dr. Lisa Reznick offers conservative treatment options for all types of general orthopedic issues, while specializing in surgeries of the hand, wrist, and elbow.