Treatment For Dupytren's Contracture
What is Dupytren's Contracture?
Dupuytren’s contracture is a progressive thickening and tightening of tissue in the palm of the hand and fingers. It causes one or more of the fingers to become permanently bent in a flexed position, typically the ring and little fingers. It is a type of finger deformity.
The condition can begin as small hard nodules that form just under the skin of the palm. These worsen over time until the fingers can no longer be straightened. Dupuytren’s is not life threatening and rarely painful but is progressive and can cause substantial disability.
Dupytren's Contracture causes
As the connective tissue in the hand thickens, string-like cords develop beneath the skin pulling the affected fingers towards the palm. Dupuytren’s is a genetic condition with at least 13 different genes having been identified that predispose to the disease. That said due to the way the genes work many people have no family history. There are some environmental factors that may further increase your chance of developing the condition including alcohol, smoking and using vibrating tools.
Dupytren's Contracture symptoms
Itching, pain, cramp and discomfort are reported by some patients; others merely notice firm swellings or cord-like structures in the palm of the hand. Symptoms can be mild and often painless and may not require treatment. It is however a progressive condition that may worsen over time. The condition becomes troublesome if the cords cause the fingers to become fixed in a bent posture. This may cause difficulties with hobbies and activities of daily living.
Dupytren's Contracture diagnosis
A diagnosis is usually made by your consultant conducting a physical examination of your hands. They may ask when you first noticed a change, and if you have had any related trauma or injury. Your consultant may do a table-top test, meaning they will ask you to place your palm on a flat surface to see if your fingers and palm will lie flat.
Dupytren's Contracture treatment
The best course of treatment will depend on the severity of the condition, your work, your hobbies and the degree to which the contracture affects your function. Your consultant will explain the treatment options and benefits of each available to you.
Non-surgical treatment
Needling, or needle aponeurotomy, is a minimally invasive procedure that uses the point of a needle to sever the tightened cords and relieve contractures. Small punctures are made in the skin and by manipulating the tip of the needle; your consultant can cut through the contracted tissue.
This is a simple low risk procedure which is quick to recover from however there is a high recurrence rate and only limited patterns of disease are suitable.
Surgical treatment
Surgery has long been the most common form of treatment for Dupuytren’s contracture. There are many variations to how surgery can be done and how extensive it needs to be. When surgery is performed, an incision is made in the skin over the abnormal tissue, the skin is lifted up the diseased cord is separated from the healthy tissue and removed, the incisions are closed and the hand bandaged.
Surgery provides the best chance of achieving a full correction and of maintaining that correction for as long as possible however it is a more involved procedure, a longer recovery and has a higher risk of complication that the needling.
While all of these procedures address the contracted tissue of Dupuytren’s, none of them cure the underlying disease. Therefore, recurrence of the contracture is always a possibility, no matter what treatment is performed.
Treatment options
The One Orthopaedics team specialists
Anthony Hearnden
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Shoulder, Elbow, Hand and Wrist
