The disease is divided into different stages, depending on the manifestation and severity:

1. **Early stage:** Nodule formation in the palm of the hand without significant functional limitations.

2. **Advanced stage:** Formation of cords causing finger flexion.

3. **Severe stage:** Pronounced flexion contractures, where the fingers can hardly be straightened.

4. **Recurrence:** Reappearance of the contracture after previous treatment.

The exact causes of Dupuytren's disease are not fully understood, but genetic and external factors play an important role:

• Genetic predisposition:
  • A familial clustering is common, especially among people of Northern European descent.
• Age:
  • The disease usually occurs from the age of 50.
• Gender:
  • Men are about five times more likely to be affected than women.
• Risk factors:
  • Comorbidities such as diabetes mellitus, alcohol abuse, or epilepsy.
• Mechanical stress:
  • Regular overuse of the hands, e.g., through heavy physical work.

The symptoms develop gradually and are often bilateral, with one hand often more affected:

• Nodule formation: Painless, firm nodules in the palm, often the first sign.
• Cord formation: Visible or palpable cords that extend along the flexor tendons.
• Flexion contracture: Progressive shortening of the cords, leading to an inability to straighten the fingers.
• Limited function: Difficulty in grasping or holding objects, especially in advanced stages.
• Skin changes: Indentations or hardening of the skin over the affected areas.

Conservative Therapy

In the early stages, treatment can be done without surgery:

• Physiotherapy:
  • Exercises to maintain finger mobility.
• Injection Therapy:
  • Collagenase injections to dissolve the cords.
• Manual Therapy:
  • Mobilization of the hand through targeted maneuvers.

Surgical Therapy

In advanced stages or with severe functional impairment, surgery is necessary:

• Fasciotomy:
  • Cutting the thickened cords to restore finger mobility.
• Fasciectomy:
  • Removal of the diseased connective tissue.
• Dermofasciectomy:
  • Removal of the palmar aponeurosis and the overlying skin with skin grafting.

Conservative Therapy

In the early stages, treatment can be done without surgery:

• Physiotherapy:
  • Exercises to maintain finger mobility.
• Injection Therapy:
  • Collagenase injections to dissolve the cords.
• Manual Therapy:
  • Mobilization of the hand through targeted maneuvers.

Surgical Therapy

In advanced stages or with severe functional impairment, surgery is necessary:

• Fasciotomy:
  • Cutting the thickened cords to restore finger mobility.
• Fasciectomy:
  • Removal of the diseased connective tissue.
• Dermofasciectomy:
  • Removal of the palmar aponeurosis and the overlying skin with skin grafting.

To prevent or delay the progression of the disease, the following measures are recommended:

1. Regular exercise: Stretching exercises and mobilization of the fingers to maintain flexibility.
2. Ergonomic work practices: Reducing the strain on the hands through optimized tools or work techniques.
3. Minimize risk factors: Control of comorbidities such as diabetes and avoidance of alcohol abuse.
4. Early detection: Seek medical advice early at the first signs such as nodule formation.