Dupuytren’s Contracture (Dupuytren's disease) is a condition that affects the hands and fingers. It causes one or more fingers to bend into the palm of the hand. It can affect one or both hands, and sometimes affect the thumb.
Dupuytren's contracture occurs when the connective tissue in the palm thickens. Often the tissue thickens in one small area first and a “nodule” forms (a small, hard lump about 0.5-1cm) under the skin of the palm. The nodule sometimes feels tender to begin with, but this usually passes. More nodules may then develop. The nodules are non-cancerous (benign) and the condition isn't life-threatening for those who develop it, although it can be a nuisance to live with.
Over time, the nodules can extend and form cords of tissue. These cords can shorten (contract) and, if the cords run along a finger or thumb, they can pull it, so it becomes bent towards the palm. These contractures are often mild and painless, but they can get steadily worse over time.
Proposed revisions to the eligibility criteria
We will only fund surgery if patients meet the criteria below, and therefore categorised as Restricted:
Metacarpophalangeal joint (MCPJ) and/or Proximal IP (flexion) joint contracture of 30° and/or more (inability to place hand flat on table)
Where such condition (either MCPJ or PIPJ) is severely impacting on activity of daily living with a demonstrable significant detrimental impact on daily activities with functional limitation.
Young patients with early onset disease (25-40) +/- family history, whose clinical assessment demonstrates that they will benefit from surgery.
Further information and guidance
NICE IPG 43 – https://www.nice.org.uk/guidance/ipg43 - published February 2004 Needle fasciotomy for Dupuytren’s contracture. Current evidence on the safety and efficacy of needle fasciotomy for Dupuytren’s contracture appears adequate to support the use of the procedure, provided that normal arrangements are in place for consent, audit and clinical governance.