Dupuytren’s Contracture Treatment: A Complete Guide
Dupuytren’s contracture is a condition that causes tissue beneath the skin of your palm (fascia) to thicken and form tough bands called cords. These cords tighten and gradually pull one or more fingers into a bent position.
For some people, the condition may only cause lumps in the palm and never worsen, while others may develop severely bent fingers that cannot be fully straightened.
If the lumps or contractures aren't bothering you, your healthcare provider might recommend a “watch and wait” approach. But if contractures are affecting your daily activities, there are several treatment options available.
Work with your healthcare provider to decide on the best treatment for you.
In the early stages of Dupuytren’s contracture, physical and occupational therapy may be helpful for maintaining range of motion of the fingers, and braces or splints may be used to stretch them.
Splinting may be a first option to help you feel more comfortable and more functional, but it won’t keep the disease from progressing, says Jonathan Tueting, MD, an orthopedic surgeon specializing in shoulder, elbow, and hand surgery at Rush Orthopaedics and Sports Medicine in Aurora, Illinois.
When additional treatment is needed, your healthcare provider may recommend injections or radiation therapy.
Steroid Injections
If you have painful nodules in the early stages of Dupuytren's contracture, corticosteroid (steroid) injections may help soften and flatten them.
Steroid injections are not effective for preventing the progression of the disease or making it go away, says Dr. Tueting. In a review of studies, about half the people who received steroid injections had a return of symptoms within three years.
Collagenase Injections
Collagenase clostridium histolyticum (Xiaflex) is an injectable enzyme that helps break down the cords in the palm.
Collagenase injections are done in two steps: At the first appointment, the healthcare provider injects the enzyme into the cord. At a second appointment, one or two days later, the healthcare provider numbs the area and manipulates the finger to break up the cord and allow the finger to straighten.
Most people tolerate the treatment well, but some experience bruising, swelling, or pain in the hand that was injected, or redness and irritation around the injection site. About 50 percent of those who receive collagenase injections will see their contracture return within five years.
There are pros and cons of nonsurgical treatments. While there’s no cutting involved and recovery time is much shorter than with surgery, the condition may return, requiring further treatment over time.
Radiation Therapy
Low-dose radiation therapy might help in the early stages of Dupuytren's contracture. Tueting explains that this treatment works by stopping the cells that cause tissue thickening from becoming more active. But it’s still unclear how well radiation therapy works over the long term.
Like other treatments, radiation therapy has potential risks, including problems with wound healing if surgery is needed later.
If other treatments haven't provided enough relief, surgery may be recommended. Each surgical approach is different. Your healthcare provider will make recommendations based on how the contracture affects your daily activities.
Generally, less involved procedures may mean a quicker recovery, but your symptoms might return sooner, says Claude Jarrett, MD, an orthopedic surgeon based in Wilmington, North Carolina, who specializes in upper extremity surgery. More complex surgeries often need more recovery time, but the results may last longer, he adds.
Needle Aponeurotomy
One of the least invasive surgical options is needle aponeurotomy (or needle fasciotomy), which can be done in a medical office. After numbing the area with a local anesthetic, a healthcare provider uses the tip of a needle to poke tiny holes in the tight cord beneath the skin.
This weakens the cord enough that your finger can be gently stretched back to a straighter position. This procedure can help improve finger movement, even in severe cases, with few side effects.
Fasciotomy
A fasciotomy is a minor surgery that involves making an incision in the palm to break up the tight cords. You’ll typically receive a local anesthetic to numb your hand. While the cord isn't removed in a fasciotomy, breaking it up helps decrease the contracture and improve finger movement.
This procedure works well for many people, though some may eventually need additional treatment.
Partial Palmar Fasciectomy
If contractures are severe, a partial palmar fasciectomy (removal of the fascia) may be recommended. This surgery involves removing portions of the cord through multiple incisions in the palm and affected finger or fingers.
Depending on the extent of the surgery, a skin graft, in which healthy skin from another part of your body is used to cover the wound, may be necessary to heal the wound.
Compared with00 a needle fasciotomy (aponeurotomy), this surgery requires more healing time, but it often provides longer-lasting results, with about 20 percent of people experiencing a return of their contracture.
Dermofasciectomy
If you have a more severe case of Dupuytren’s contracture or if the contractures return after previous treatments, you may need a dermofasciectomy (removal of fascia and skin). In this procedure, the surgeon removes both the cord and the overlying skin from your palm and uses a skin graft to cover the area.
A dermofasciectomy can reduce the chance of the contracture coming back. Some of the risks of this procedure include the skin graft not working well, scarring, and a higher chance of complications, including infection and chronic pain syndrome.
The goals of rehabilitation after surgery are to reduce swelling, improve hand function, and reduce recurrence of the contracture.
Hand Therapy
“Hand therapy is very important after surgery to maximize success,” says Jarrett. A hand therapist can show you exercises that help strengthen your hand and improve how well you can move your fingers. Working with a hand therapist can also help manage swelling and help with wound healing.
Splinting
Splinting may be used after certain surgical procedures, although it’s unclear whether it reduces the risk of recurrence. Tueting recommends using a night splint for about six weeks after needle aponeurotomy or surgery for more severe contractures.
Lifestyle changes won’t stop Dupuytren's contracture from developing or progressing, says Jarrett, but making a few adjustments in your daily life may help ease your symptoms and support healing after surgery.
Quitting Smoking
“There is a correlation with smoking, tobacco use, and progression of Dupuytren’s,” says Tueting. The nicotine in tobacco can reduce blood flow to your hands, which may cause the disease to progress faster, he adds. Quitting smoking is helpful for your overall health, and it can improve wound healing if you need surgery.
Limiting Alcohol
Excessive alcohol use has been linked to Dupuytren's contracture, says Tueting. While alcohol has not been proven to cause the condition, limiting alcohol intake may be helpful as part of your overall health management.
Blood Sugar Control
“If patients are diabetic, they can have potentially worse disease,” says Tueting. Diabetes can also make wound healing more difficult, which is something to be aware of if you’re considering surgery. Keeping blood sugar levels in check through a healthy diet, exercise, and medication management may help treatment for Dupuytren’s contracture work better.
Hand Protection
You may notice your symptoms getting worse with certain movements or heavy use of your hands. While you don't need to avoid these activities completely, you can make them easier on your hands by wearing padded gloves during tasks that require heavy gripping and using tools and kitchen supplies that are designed to be easy on the hands.
“The vast majority of the time, Dupuytren’s disease is painless,” says Tueting. When pain does occur, it's usually from nodules in the palm, which can be treated with steroid injections.
Dupuytren's contracture is a condition that causes the tissue beneath your palm’s skin to thicken and form tough cords, gradually pulling one or more fingers into a bent position.
Treatment often starts with splinting or injections, which can help improve finger movement without surgery.
Different types of surgery, such as fasciotomy and fasciectomy, are available when needed, though they require more recovery time.
Work closely with your healthcare provider and protect your hands during daily activities to manage the condition.
