Disease Progression

How Dupuytren’s Disease Progresses
Factors That Influence Progression
Diagnosis of Dupuytren’s Disease

How Dupuytren’s Disease Progresses

Dupuytren’s disease is associated with distinct physical features that change over time. For some patients, it may progress slowly, over many years. For others, it may progress over a period of months.

Early signs. An early sign of Dupuytren’s disease is often the development of nodulesNodule
A small knot or lump. , or lumps, under the skin of the palm. During the early stages, other changes can also occur—pits or dimples may form and the skin may visibly thicken.

• Nodules. Nodules develop as the tissue under the skin of the palm (called palmar fasciaPalmar fascia
  Fibrous tissue that lies under the skin of the palm. [pronounced “FAH shuh”]) begins to thicken. They usually appear near the crease in the palm just below the base of the fingers. Nodules are usually painless and feel firm and solid when pressed. Pain can result if nodules put pressure on a nearby tendon. As the disease progresses and contractures begin, nodules tend to disappear.
• Pitting and dimpling. Changes in the early stage of Dupuytren’s disease, changes in how the fasciaFascia
  Sheet of fibrous tissue that lies beneath the skin. connects to the overlying skin occur, causing the skin to appear dimpled or pitted.

Cords and contracture. As Dupuytren’s disease progresses, nodules can gradually develop into a rope-like cord that extends from the palm into the finger. This cord develops from the tissue of the pretendinousPretendinous bands
Extensions of the palmar fascia that extend to the fingers. (pronounced “pree TEN din us”) band. Over time, these cords tighten and shorten, pulling the finger downward. As the disease progresses, the amount of contracture can increase and range of motion can decrease.

Progression. Dupuytren’s disease initially affects one finger, usually the ring finger or little finger. The middle finger is involved less often, and the index finger and thumb are rarely involved. Contracture often affects the joint at the base of the finger (or MP jointMP joint
Joint at the base of the finger; also called the metacarpal phalangeal joint. ) first and may eventually affect other joints on the same finger. For some people, contracture may develop in multiple fingers and may affect both hands.

How progression affects daily activities. Performing daily tasks can become more difficult as the degree of contracture increases and range of motion decreases. An individual may decide to seek medical advice when the condition becomes disruptive. Many patients do not seek treatment until cords have formed.

Watch a video about Dupuytren’s disease progression and its impact on daily activities.

Factors that Influence Progression

The rate and extent of disease progression can vary widely among individuals. Two related factors—family history and age of onset—may influence how quickly the disease progresses and how severe the signs become.

• Family history. Patients with a family history of Dupuytren’s disease tend to develop signs at a younger age than those who do not have family members with the disease.
• Age of onset. Patients who develop signs of Dupuytren’s disease before age 50 usually experience a faster progression and more severe signs and symptoms than patients who develop the disease later. This rapid progression usually involves multiple fingers and often causes Dupuytren’s-related changes in the knuckles ( Garrod’s padsGarrod’s pads
  Enlargement of the knuckles associated with Dupuytren’s disease; also called knuckle pads. ) and feet ( Ledderhose diseaseLedderhose disease
  Disease involving abnormalities of the fascia on the underside of the foot, resulting in nodule formation; also called plantar fibromatosis. ), as well as the penis ( Peyronie’s diseasePeyronie’s disease
  Disease in which abnormal fibrous tissue causes bending of the penis; often associated with Dupuytren’s disease. ).

Diagnosis of Dupuytren’s Disease

A primary care physician (such as a family doctor, internist or general practitioner) may be the first healthcare professional an individual contacts after noticing signs of Dupuytren’s disease. To confirm diagnosis, the primary care physician will likely give a referral to a physician who specializes in diagnosing and treating hand conditions. This specialist may be a hand surgeon, orthopaedic surgeon or plastic surgeon.

During diagnosis, a doctor will carefully review an individual’s medical history and conduct a thorough physical examination. (Learn more about how to prepare for your appointment here.) Some types of information that will be useful for diagnosis include:

• Family history of Dupuytren’s disease
• History of trauma or injury to the hand or wrist
• When signs appeared
• How quickly signs and symptoms have developed
• How much the condition interferes with daily activities
• Previous treatments and outcomes

During the physical examination, the doctor may examine the hands for signs of Dupuytren’s disease (such as PittingPitting
Dimple or indention on the surface of the palm. , nodulesNodule
A small knot or lump. or cords) and may also examine other parts of the body (such as the feet) for evidence of ectopic disease. The doctor will also look for signs of other conditions that may be mistaken for Dupuytren’s disease, such as trigger finger, arthritis, and callous or tumor formation.

The physical exam may include a “table-top test,” which involves placing the hand palm-side down on a table. If contracture is present, the hand will not lie flat. The amount of contracture may also be measured in angles (or degrees), with higher numbers indicating greater bend. This information, along with how much the disease affects daily activities, is used to determine when to initiate treatment.