2 Indications and current treatments
2.1 Dupuytren's disease is a benign fibroproliferative disorder of the fascia of the hand and fingers. Its aetiology is unknown. It is characterised by connective tissue thickening in the palm of the hand, forming nodules. These nodules are thought to progress to form cords, which cause difficulty in extending the fingers. Symptoms include reduced range of motion, reduced hand function and pain. It most commonly affects the fourth and fifth fingers. Most patients are affected in both hands. There is no formal clinical definition of early disease but the term is generally used for patients with contractures of 30 degrees or less, with or without palmar disease. Not all patients have progressive disease, and the natural history of the disease is not well understood.
2.2 Treatments for Dupuytren's disease aim to restore hand function and prevent progression. These include needle aponeurotomy (percutaneous needle fasciotomy) in earlier disease, and open surgical correction (fasciotomy or fasciectomy) in later disease when secondary changes to tendons and joints have developed. Limited fasciectomy is the most commonly used open surgical treatment. Dermofasciectomy is used for advanced cases. A non-surgical treatment using injectable collagenase clostridium histolyticum is also sometimes used.