What Is Dupuytren’s Contracture and What Causes It?
Updated December 04, 2014.
For many years, treatment in the early stages of Dupuytren's contracture was a watch and wait situation. Because surgical treatment is invasive and may require a protracted recovery and rehabilitation, it was often reserved as a last resort option if symptoms started to interfere too much with daily activities.
Recently, less-invasive treatment options have given some hope that Dupuytren's contracture can be well managed, especially if treated in the earlier stages of the problem.
We do know that the worse the contracture, the harder it will be to ever have normal hand function again. Therefore, many people are looking for less-invasive treatment options, especially for early stage Dupuytren's contracture.
My doctor says the only option is surgery, is this true?
In some patients, less-invasive treatments may not be appropriate. Also, not all doctors are aware that needle aponeurotomy is a treatment option for Dupuytren's contracture. There is a controversy about the use of this treatment, and therefore not all doctors recommend needle aponeurotomy. If you want to discuss needle aponeurotomy with a physicain, you can find a list of the physicians performing this procedure on the Dupuytren's-Online website.
What is the surgical procedure for Dupuytren's contracture?
The surgical procedure for Dupuytren's contracture is known as a fasciectomy, where segments of the palmar fascia are removed. The downside of surgery is that there are significant risks associated with the procedure. The most common is that scar tissue can form after surgery leading to a problem similar to Dupuytren's contractre, but with scar tissue formation. Second, the Dupuytren's can return, and doing surgery a second time is fraught with problems. Other problems with surgery include nerve injury, infection, and prolonged healing.
What is the rehabilitation for treatment of Dupuytren's contracture?
Rehabilitation after needle aponeurotomy is relatively quick. Usually patients can resume normal activities immediately, and are instructed to refrain from sports and heavy labor for about a week. Depending on the type of contracture, a removable splint may be given to be worn a few hours each day.
Rehabilitation after surgery varies significantly. Patients with minimal contractures may be able to resume normal activities one the incisions heal, within a few weeks. More severe contractures may require months of splinting and rehabilitation with a hand therapist to prevent scar tissue formation.
Sources:
Benson LS, et al. "Dupuytren's contracture" J. Am. Acad. Ortho. Surg., Jan 1998; 6: 24 - 35.
Eaton C, The Hand Center © 2007.
Murphy K, "Straightening Bent Fingers, No Surgery Required" The New York Times July 24, 2007.
For many years, treatment in the early stages of Dupuytren's contracture was a watch and wait situation. Because surgical treatment is invasive and may require a protracted recovery and rehabilitation, it was often reserved as a last resort option if symptoms started to interfere too much with daily activities.
Recently, less-invasive treatment options have given some hope that Dupuytren's contracture can be well managed, especially if treated in the earlier stages of the problem.
We do know that the worse the contracture, the harder it will be to ever have normal hand function again. Therefore, many people are looking for less-invasive treatment options, especially for early stage Dupuytren's contracture.
Treatment Options
There are four primary options for treatment currently available for the treatment of Dupuytren's contracture:- Observation
Observation is often considered in the early stage of Dupuytren's contracture. This is usually the best option for people who are not impaired by their hand function. This may include people with minimal contractures, or people who do not use their hands, and can perform all their usual activities. - Needle Aponeurotomy
Needle aponeurotomy is a procedure developed in France, that has only recently become more popular in the United States. Using no incisions, a needle is used to separate the Dupuytren's cords, and restore some or all of finger motion. Needle aponeurotomy is most successful in the earlier stages of Dupuytren's contracture.
- Collagenase Injections
Collagenase is an enzyme that is produced by a bacteria that is injected into a Dupuytren's cord. The enzyme works to dissolve the tight Dupuytren's tissue. One day after the injection, after the enzyme has done it's work, you return to the doctor to have the finger manipulated to break up the tightened tissue, and restore finger mobility. - Surgery
Surgery is performed to remove the palmar fascia from the palm of the hand. Surgery can be effective at restoring function, and may be necessary in the later stages of Dupuytren's contracture. The surgery usually has a prolonged rehabilitation.
My doctor says the only option is surgery, is this true?
In some patients, less-invasive treatments may not be appropriate. Also, not all doctors are aware that needle aponeurotomy is a treatment option for Dupuytren's contracture. There is a controversy about the use of this treatment, and therefore not all doctors recommend needle aponeurotomy. If you want to discuss needle aponeurotomy with a physicain, you can find a list of the physicians performing this procedure on the Dupuytren's-Online website.
What is the surgical procedure for Dupuytren's contracture?
The surgical procedure for Dupuytren's contracture is known as a fasciectomy, where segments of the palmar fascia are removed. The downside of surgery is that there are significant risks associated with the procedure. The most common is that scar tissue can form after surgery leading to a problem similar to Dupuytren's contractre, but with scar tissue formation. Second, the Dupuytren's can return, and doing surgery a second time is fraught with problems. Other problems with surgery include nerve injury, infection, and prolonged healing.
What is the rehabilitation for treatment of Dupuytren's contracture?
Rehabilitation after needle aponeurotomy is relatively quick. Usually patients can resume normal activities immediately, and are instructed to refrain from sports and heavy labor for about a week. Depending on the type of contracture, a removable splint may be given to be worn a few hours each day.
Rehabilitation after surgery varies significantly. Patients with minimal contractures may be able to resume normal activities one the incisions heal, within a few weeks. More severe contractures may require months of splinting and rehabilitation with a hand therapist to prevent scar tissue formation.
Sources:
Benson LS, et al. "Dupuytren's contracture" J. Am. Acad. Ortho. Surg., Jan 1998; 6: 24 - 35.
Eaton C, The Hand Center © 2007.
Murphy K, "Straightening Bent Fingers, No Surgery Required" The New York Times July 24, 2007.
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