Dupuytrens Contracture

Dupuytren's (du-pwe-TRANZ) contracture is a deformity of the hand that usually develops slowly over years.

It affects a layer of tissue that lies under the skin of your palm and fingers causing nodules, thickening and cords of tissue that can pull one or more fingers into a bent position. While this is a benign condition, it is progressive in nature. As the fingers tighten, everyday activities such as washing your face, putting on gloves, shaking hands or clapping become more and more difficult. The span of the hand is reduced making use of the hand a little more awkward.

Dupuytren’s contracture mainly affects the ring finger and little fingers but other fingers may be involved. It is seen most often in older men of Northern European descent and thought to have been brought to your shores by the vikings! Many treatments are available to relieve the symptoms caused by the progression of Dupuytren’s contracture.

Treatment Options

1. Monitoring

If you have early disease i.e. a nodule, thickening or cord on your hand and you can comfortably leave your hand flat on the table, then you do not need to consider any treatment option for now. You should monitor the condition for progression. One exception to this may be if the nodule or thickening on the palm is causing pain or discomfort.

2. Non surgical Collagenase (Xiapex):

Collagen is the main structural protein in the body and there are many types. The collagen that makes up Dupuytrens cords and nodules (type I and III collagen) is targeted by a new biological enzyme – collagenase. It cleaves and digests the Dupuytrens tissue to break it down. Collagenase could potentially do the same to ligaments or tendons.

It is given as an injection while awake. The hand is wrapped in a padded protective bandage and a review is required 2 days later where you may need some local anaesthetic to manipulate the finger a little to help it straighten. Common side effects are localised bruising and swelling – both usually subside in 5-7 days. Many patients require more than one injection.

3. Local anaesthetic procedures:

a) Needle aponeurotomy:

This technique was popularised by a French dermatologist Dr. Jean Luc Lermusiaux. Many travelled from all over Europe for a visit to Paris and have their finger straightened at the same time! It is a procedure done using the tip or bevel of a needle as a micro blade inserted under the skin to divide the tight fibres of Dupuytrens in the hand allowing the finger to straighten. You will get local anaesthetic to numb the skin prior to the procedure. It’s best for primary disease with a single palmar cord.

b) Surgery – Limited palmar excisions:

Some cases can be performed under local anaesthetic. This is usually where the disease is confined to the palm.

4. General aneasthetic procedure:

This is surgery usually done under general anaesthetic though there are cases suitable for local anaesthetic. It is done as a day case which means getting home that same day. Various incisions are made in the palm to expose the Dupuytrens disease and subsequently excise it.

You may require a skin graft depending on the severity of the disease and the involvement of the skin. The stitches stay in about 2 weeks and it is common to need the help of a hand therapist to help with your rehabilitation post-procedure. Recovery time is variable

5. Radiotherapy

Radiotherapy is very rarely used in the treatment of Dupuytrens. The aim is to prevent or postpone the need for surgical intervention.

The mechanism of action of radiation therapy is unclear, but it is thought to affect the development and growth rate of fibroblasts within the palmar fascia.

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