Dupuytren’s disease is a condition where the finger starts to curl into the palm. Previously called the Viking disease because of a perceived Scandinavian origin, we now know that actually it affects all people, but Caucasians predominantly. It tends to run in families, and can affect the toes and other body parts aswell. For reasons we don’t understand the body lays down layers of scar tissue along some of the connective tissue (fascia) in the hand, and over time the scar tissue contracts pulling the fingers down.

In the early stages Mr Wharton can help with diagnosis. Unfortunately stretching exercises and hand therapy don’t classically help to prevent the contracture from occurring. When it becomes very bothersome Mr Wharton offers two types of treatment. For thick cords in the palm these can be divided using a needle under local anaesthetic. This disrupts the cord, and allows the finger to straighten. This procedure generally allows an immediate return to activity. However, when the cords have entered the finger it becomes less safe to use needle fasciotomy, because the position of the nerve and artery to the finger become less certain. Instead open surgery (fasciectomy) is usually advised to remove the Dupuytren’s tissue. This procedure can be conducted under general anaesthetic, regional anaesthetic (nerve block around the shoulder) or under local anaesthetic alone depending on the complexity of the case. Afterwards patients need to elevate their hand for at least five days and keep the wounds dry for 2-3 weeks. The hand therapists have a crucial role in helping rehabilitate the hand after this surgery, and in providing a splint if the finger starts to curl down again.