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Ask the doctor: The GP said a lump on my hand is Viking disease. How do I treat it?

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There are varying forms of treatment for Dupuytren’s disease

There are varying forms of treatment for Dupuytren’s disease

There are varying forms of treatment for Dupuytren’s disease

Q: I’ve had a small lump on my hand for the past few months and it’s growing noticeably in size. My GP said it was Dupuytren’s contracture, a condition in which one or more fingers become permanently bent in a flexed position. I didn’t really get any more information from her other than a letter for an orthopaedic specialist. I’m wondering at what point do I need to address the issue, what’s the normal course of action?

Dr Grant replies:  Dupuytren’s disease (DD) is a benign, slowly progressive fibro-proliferative disease of the fascia in the palm of the hand. The fascia of the hand is a layer of tissue that helps to anchor and stabilise the skin on the palm side of the hand. Without the fascia, the skin on the palm of the hand would move as easily as the skin on the back of the hand. The ring and little fingers are most affected, either on one or both hands, often progressing to form contractures.

The disease begins with fascial thickening and tightening, observed as a lump or nodule in the palm. It is usually painless and often goes undiagnosed for many years. The nodules in the palm of the hand may progress over years to form longitudinal fascial bands referred to as cords. The fingers are contracted by the taut cords and ultimately hand function becomes impaired. In the worst-case scenario, the development of joint stiffness and loss of full extension of the affected fingers occurs over a variable period of time, typically years.

Males generally aged over 50 are more commonly affected by DD and the incidence continues to rise with age. There is a genetic predisposition to the development of the disease as it often runs in families. There are a few conditions associated with DD.

People who smoke, drink plenty of alcohol or have diabetes or seizure disorders are more likely to develop DD. The standard treatment for moderate to severe flexion contractures is a surgical procedure called a subtotal fasciectomy. This involves making a cut along the palm of the hand to remove the abnormal tissue. It is a day case procedure performed under general or local anaesthetic. Recovery time is four to 12 weeks. The complications include pain, scarring, numbness in a finger caused by accidental injury to the nerves, loss of sensation (usually temporary), accidental injury to a blood vessel in the hand, poor wound healing, infection and stiffness. A less invasive procedure called fasciotomy can be performed under local anaesthetic with shorter recovery time (about two weeks) but carries the risk of recurrence of the disease.

During this procedure an incision is made into the palm and the thickened cords are divided. Following surgery, patients need to wear a splint for a few days and at night for three to six months. Patients also need to practice specific hand exercises to aid rehabilitation for up to six months.

Recent developments include collagenase enzyme injections directly into the cords. Within 24 to 72 hours the enzymes weaken or dissolve the contractures in the hand. Following the injection, the hand needs to be manipulated to straighten the bent fingers and pull apart the restrictive cords. Some patients try steroid injections to help ease hand pain. Lastly, needle aponeurotomy is a minimally invasive procedure by passing a sharp hypodermic needle back and forth through the cords to weaken and break them down.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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