Dupuytren’s and Ledderhose Disease

• Understanding the disease
• Treatment options
• Side effects of treatment

Stephen Shamp, MD MSEE

David Bloom, MD PhD

Matthew Culbert, MD

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Dupuytren’s and Ledderhose Disease

• Dupuytren's disease, also known as Dupuytren's contracture, is a progressive hand condition that affects the connective tissue beneath the skin in the palm and fingers. It is characterized by the development of thickened cords of tissue, leading to the formation of nodules and contractures. These contractures can cause fingers to bend inward, leading to limited mobility and functional impairment.

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• Ledderhose disease is a similar process on the foot

Dupuytren’s Treatment Options

• Radiation Therapy
• Low-dose radiation therapy is utilized to slow down or halt the progression of the disease and prevent contracture formation.
• Physical Therapy
• Physical therapy can help maintain finger mobility and prevent further contracture progression
• Splinting and Orthotics
• can help keep the affected fingers extended, preventing or reducing contracture formation.
• Injectable Medications
• enzymes that breaks down the collagen in the cords, allowing manual manipulation and straightening of the affected fingers.
• Surgery
• Fasciotomy - release or division of the contracted cords through a small incision in the palm. This procedure provides temporary relief by creating a gap in the cords, but recurrence of contractures is common
• Fasciectomy - Fasciectomy is a more extensive surgical procedure where the diseased tissue is completely removed. This can be performed as a partial fasciectomy (removal of the affected cords) or as a dermofasciectomy (removal of the affected cords and overlying skin).

Simulation (planning session)

• The area that needs to be treated will be outlined
• A custom shield will be made to prevent radiation outside of the area that needs to be treated

Logistics of Low-Dose Radiation treatment:

• 10 treatments total
• 5 treatments followed by a 12 week break and then the remaining 5 treatments
• Treatment days are Monday-Friday
• Daily treatment takes 15 minutes or less. You will be given a schedule
• You do not feel anything during treatment, you will not be radioactive, you are allowed to drive yourself to and from treatment if you are currently allowed to drive
• Superficial electron therapy will be used

Low-Dose Radiation Results

• Prevents further contracture in about 70% of patients
• Most effective in early stages of disease and when the disease is active

Side Effects/Risks of Low-Dose Radiation

• Redness
• Dryness
• Itching
• Secondary malignancies have not been reported after radiation for Dupuytren’s, but there is likely a small risk many years after the radiation