Meet John
At 65, John started noticing a thickening in the palm of his right hand, making it harder to fully straighten his fingers.
Everyday tasks like shaking hands and gripping tools became increasingly uncomfortable.
Concerned, John visited The Upper Hand Clinic, where our team diagnosed him with Dupuytren’s disease, a condition where the connective tissue in the palm thickens and contracts over time.
Understanding Dupytren's Disease
Dupuytren’s disease is a condition where the connective tissue in the palm thickens and forms cords, causing the fingers—often the ring and little fingers—to bend towards the palm.
While the exact cause is unknown, it is thought to be influenced by genetics and is more common in people of Northern European descent. Factors such as age (usually over 50), being male, and having a family history of the condition can increase the risk.
Treatment options depend on the severity of the condition. In its early stages, monitoring and hand therapy can help maintain mobility.
For more advanced cases, minimally invasive procedures like needle fasciotomy or collagenase injections, or surgical release, may be recommended to restore finger extension.
Post-treatment hand therapy plays a crucial role in regaining function and preventing recurrence.
At The Upper Hand Clinic, we provide expert care and tailored treatment plans to help you manage Dupuytren’s disease and maintain hand function for the long term.
What is Palmer Fascia and how is it Dupytrens treated?
The palmar fascia is a dense, fibrous tissue layer located beneath the skin of the palm. It helps stabilise the skin, supports grip, and anchors the tendons, nerves, and blood vessels that run to the fingers. In Dupuytren’s disease, this fascia thickens and forms nodules and cords, causing the fingers to contract and lose full extension.
Surgical treatments for Dupuytren’s disease aim to release or remove the affected tissue, restoring hand function. A fasciectomy involves removing the diseased fascia, while a fasciotomy involves cutting the cords to straighten the fingers.
In severe cases, a dermofasciectomy may be performed, where both the affected fascia and overlying skin are removed, often requiring a skin graft. Surgery is typically followed by hand therapy to optimize recovery, improve mobility, and reduce the risk of recurrence.
At The Upper Hand Clinic, we work closely with patients throughout the surgical and rehabilitation journey to achieve the best outcomes.
How hand therapists can help Dupytrens Disease?
If you're experiencing symptoms of dupytren's or have had dupytren's surgery , hand therapy can be a key part of your recovery process. The goal of therapy is to manage wound and scar healing reduce pain and inflammation, restore finger movement, and prevent the facilitate return to work and normal activities of daily living Below are some of the common treatments we may use in our clinic:
Preoperative Management
For those with early-stage Dupuytren’s disease or those preparing for surgery, hand therapy focuses on maintaining mobility, strength, and function.
Pre-surgical therapy includes:
-
Education: Learning about the condition and how to protect your hands during daily activities.
-
Stretching Exercises: Gentle stretching techniques can help maintain range of motion in the fingers and reduce stiffness.
-
Splinting: Custom splints may be used to support the hand and prevent further contracture progression.
-
Activity Modification: Advice on how to adapt tasks to minimize strain on the affected hand.
This proactive approach can help slow the progression of the disease and prepare your hand for surgery, if needed, by maintaining joint and tissue flexibility.
Post Surgical Therapy
After surgery for Dupuytren’s disease, hand therapy is essential to ensure optimal recovery.
Post-surgical therapy includes:
-
Wound Care: Guidance on caring for surgical incisions to promote healing and prevent infection.
-
Scar Management: Techniques such as massage and silicone gel applications to reduce scarring and maintain skin flexibility.
-
Splinting: Custom splints may be provided to support finger extension and prevent recurrence of contractures.
-
Strengthening and Stretching Exercises: A tailored exercise program to restore strength, range of motion, and coordination in the affected hand.
-
Edema Management: Techniques like compression wraps and manual lymphatic drainage to reduce swelling and improve comfort.
Collaboration with your medical team
As Dupytren's disease is a progressive disease that is not "cured" hand therapists communicate closely with medical providers including hand surgeons to discuss optimal times for intervention based on objective measurements as well as pain and functional goals
Whether you’re managing Dupuytren’s disease conservatively or recovering from surgery, our goal is to help you regain confidence and independence in your daily activities
Early intervention with hand therapy can prevent symptoms from worsening and help you regain full function of your hand.
Frequently asked questions about Dupytren's Disease
What Causes Dupytren's Disease?
The exact cause of Dupuytren’s disease remains unknown, but it is believed to be influenced by genetic and environmental factors. It is more common in individuals of Northern European descent and tends to run in families.
Known risk factors include:
-
Genetics: Having a family history significantly increases your likelihood of developing the condition.
-
Age and Gender: It is more common in men over 50 years of age.
-
Lifestyle Factors: Smoking, excessive alcohol consumption, and diabetes are associated with a higher risk.
-
Dupuytren’s disease is not caused by overuse or injury to the hands, though it may appear more prominent in individuals with active lifestyles.
The best treatment for trigger finger depends on the severity of your symptoms. In many cases, conservative treatments like splinting, hand therapy exercises, and activity modifications are effective in resolving symptoms.
A personalised hand therapy program can often lead to significant improvements without the need for more invasive treatments. If symptoms persist, corticosteroid injections or, as a last resort, surgery may be recommended.
How long does it take to recover from Dupytren's surgery?
Recovery from Dupuytren’s hand surgery depends on the type of procedure performed and the severity of the contractures. Common surgeries include fasciotomy (cutting the thickened cords) and fasciectomy (removing the affected tissue).
Recovery timelines typically look like this:
-
Initial Healing: Stitches are usually removed within 10–14 days after surgery. Swelling and tenderness may persist for several weeks.
-
Functional Recovery: It may take 6–12 weeks to regain full hand function, depending on the extent of the surgery and adherence to hand therapy.
-
Therapy and Exercises: Hand therapy is crucial for restoring strength and range of motion. You may need to wear a splint during the recovery phase.
It’s important to follow your surgeon and therapist’s advice to ensure the best possible outcome.
How do I prevent contractures from getting worse?
While there is no guaranteed way to stop Dupuytren’s disease from progressing, there are steps you can take to slow its progression and maintain hand function:
-
Early Intervention: If you notice signs of Dupuytren’s disease, such as lumps or thickening in your palm, consult a hand specialist. Early treatment options like enzyme injections or needling techniques can reduce the risk of severe contractures.
-
Hand Therapy: Gentle stretching exercises and splinting may help maintain range of motion. Your hand therapist can provide personalized exercises to prevent worsening contractures.
-
Lifestyle Modifications: Reducing risk factors like smoking, alcohol consumption, and managing conditions such as diabetes may help slow progression
-
While these strategies cannot reverse Dupuytren’s disease, they can be effective in managing symptoms and delaying significant interventions like surgery.
Will Dupytren's disease return after surgery?
Unfortunately, Dupuytren’s disease can return even after surgery. Recurrence rates vary depending on the type of treatment and individual factors.
Research suggests:
-
Fasciotomy Recurrence: Recurrence is relatively high, with rates reported between 50–60% within five years.
-
Fasciectomy Recurrence: Recurrence rates are lower, ranging from 20–40% after five years, as this procedure removes more affected tissue.
-
Enzyme Injections or Needling Techniques: These non-surgical methods have higher recurrence rates compared to surgery.
While recurrence is common, regular follow-up with a hand specialist and proactive hand therapy can help manage symptoms effectively if the condition returns.