“Viking’s Disease” is the name commonly used to refer to Dupuytrens contracture in the hand. While we do not know the specific cause of Dupuytrens, this condition is more common in people with Nordic or Northern European ancestry. The condition has high prevalence in Scandinavia, Iceland, the British Isles, France, and Germany – all places where Vikings inhabited during the 9th to 13th centuries. There is a much lower prevalence in people of African and Asian ancestry.
What is Dupuytrens contracture?
Dupuytrens contracture is known for increased fibrous tissue formation in the palms of the hands and in the fingers. Early in the course of the disease process, nodules of fibrous tissue develop in the palm. In some patients, these nodules develop into cords which gradually bend the fingers into a flexed position. Over time, the finger joints can become stiff and more difficult to straighten. This is called a flexion contracture in the joint. Severe contractures in the fingers can develop which significantly impair the use of the hand.
The Dupuytrens disease progression is highly variable: some people develop finger contractures early on, while other people progress much more slowly. Not everyone with a palmar nodule will develop a cord or contracture in the finger. This is why many doctors recommend watchful waiting, or observation, initially.
What are risk factors for Dupuytrens Contracture?
Risk factors for Dupuytrens disease include: male sex, family history of the condition, Northern European ancestry, smoking, alcohol abuse, use of seizure medications, and diabetes. People with Dupuytrens disease in the hands are also prone to plantar fibromatosis in the feet (Ledderhose), penile fibrosis (Peyronie’s disease), adhesive capsulitis (frozen shoulder), and nodules on the back of the finger joints (knuckle pads). Research has increased over the past several decades. However, there is still much to be learned about Dupuytrens.
History of Dupuyrens Disease
Doctors have known about Dupuytrens disease for many centuries. The condition is named after Guillaume Dupuytren, who was a French surgeon in the 1800s. He described a surgical treatment of this condition before the advent of modern anesthesia and antibiotics! The condition has also been called “Viking’s disease” because it is more common in people with Nordic or Scandinavian ancestry. Interestingly, the disease has also been called the “Curse of the MacCrimmons” due to a high prevalence within a Scottish family of bagpipers in the 1500s. Famous people who have been afflicted with this disorder include President Ronald Reagan, Prime Minister Margaret Thatcher, pianist Micha Dichter, and NFL quarterback John Elway.
What are the treatment options for Dupuytrens Contracture?
Treatment options are available for Dupuytrens disease at various stages of the disease process. Currently, there are no cures for Dupuytrens and no proven way to slow down the disease process. Corticosteroid injections (cortisone shots) are sometimes used to reduce pain, itching, or discomfort from Dupuytrens nodules in the palm. Steroid injections can shrink and soften the nodules in most patients, however, the nodules often come back in the future. Not all patients with palmar nodules will develop cords or contractures in the fingers. Radiation treatment is available but it is considered controversial for Dupuytrens disease.
If a joint contracture has developed from a Dupuytrens cord, there are two non-surgical treatments for Dupuytrens contracture: needle aponeurotomy and collagenase injections. Both procedures can be performed in the office without surgery. These procedures can significantly improve finger range of motion and patients have a much quicker recovery compared to surgery. Patient satisfaction is usually high for these procedures. Not all patients are candidates for these procedures. If patients are treated in the mild to moderate stages of contracture, the results are usually good to excellent, and the results frequently last many years. Severe contractures are more difficult to treat.
Needle Aponeurotomy for Dupuytrens Contracture
Needle Aponeurotomy (NA) is a minimally-invasive procedure performed under local anesthesia in the office. The Dupuytrens cord is perforated with a fine needle tip. NA is particularly useful when the primary contracture is in the palm or when a patient does not wish to have surgery. Recurrence is common with this technique, but it is a simple and inexpensive technique that can give relief for a few years. This procedure may be repeated in the future for recurrent contractures. Not all patients are candidates for this technique and complications include skin tears, infection, and nerve injury. This is a “high value” procedure, with low cost and high quality.
Collagenase Injections for Dupuytrens Contracture
Collagenase injections (Xiaflex) were FDA approved for use in the United States in 2010. The collagenase enzyme injection is used to dissolve Dupuytrens cords. The injection is performed in the office and the cord is manually “popped” by the surgeon at a subsequent visit in a few days. Although the period of time before a contracture recurs is unpredictable, recurrence of the contracture is common following collagenase injections. Not all patients are good candidates for this injection. The medication is expensive but is often covered by most insurance companies in the United States. Possible complications from collagenase injections include: tendon ruptures, skin tears, bruising, allergic reactions, and lymph node swelling.
Dupuytrens Contracture Surgery
Surgery is the tried-and-true treatment for Dupuytrens contractures in the fingers. Dupuytrens fasciectomy surgery can be performed safely to improve finger range of motion and quality of life when patients are not candidates for the non-surgical options. This surgery is performed in the operating room under a regional block anesthetic as an outpatient. This procedure often provides good to excellent results in patients with mild to moderate joint contractures. Patients will be treated with splinting, wound care, and hand therapy for a few weeks during the recovery process after surgery.
Make an appointment with a hand specialist to learn more about Dupuytrens contracture and the treatment options recommended for your case. Dr. Erickson is a hand and upper extremity specialist at the Raleigh Hand to Shoulder Center. He is a member of the American Society for Surgery of the Hand.