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	Dupuytren's Disease: Should I Have Hand Surgery?

Cause

The cause of Dupuytren's disease is unknown. Heredity is thought to be a factor, because Dupuytren's disease tends to occur most often in people of northern European descent and among close family members. The thickening of the tissue between the skin and tendons, called the palmar fascia, may be related to one or more things, such as:

• Alcoholism.
• Smoking.
• Diabetes.

Symptoms

Dupuytren's disease usually does not cause pain. When pain does occur, it often is early in the disease or may happen if inflammation develops (tenosynovitis).

The first noticeable symptoms of Dupuytren's disease may be:

• A small knot that may be visible or felt on the palm, usually near the base of your ring or small fingers. The knot is sometimes sensitive to pressure. And it may gradually thicken and begin to pull one or more of your fingers toward the palm.
• Dimpling that appears on the skin of your palm when the diseased tissue between the skin and tendons (palmar fascia) pulls on the skin.

As the disease progresses, a fibrous, ropey cord may gradually develop in the palmar fascia and connect your palm to one or more fingers, usually the ring or small finger. The cord pulls your finger toward the palm, which is called Dupuytren's contracture. Eventually you will not be able to flatten your palm on an even surface, such as a table. When it is severe, Dupuytren's contracture can make certain everyday activities—such as picking up items, putting on gloves, or washing your hands—difficult or impossible.

Other conditions that may cause symptoms similar to those caused by Dupuytren's disease include rheumatoid arthritis and work-related injuries.