Dupuytren’s contracture is a hand condition that causes one or several fingers (most often the ring and pinkie) to gradually curl inward. This is due to thickening and tightening tissue in the palm. It is a progressive condition and can make it more and more difficult to fully extend the fingers over time. This can affect everyday tasks like shaking hands, gripping objects, releasing objects, or even placing a hand flat on a surface.
Some early symptoms may include small lumps or nodules in the palm, a tightening sensation, or dimpling of the skin. Over time, the fingers may become stuck in a bent position, limiting movement and flexibility.
Hand and shoulder surgeon Dr. Claude Jarrett shares his thoughts on this progressive hand condition and the advanced treatment options and support the orthopaedic team at Wilmington Health provides.
Do we know what causes the contracture in the hand?
The exact cause of this condition is still unknown, but there is likely a strong genetic or hereditary component. Some research suggests a possible relationship between smoking, alcohol consumption, weight, and age, but the data is limited, so it’s unclear if altering one’s lifestyle can directly prevent symptoms of Dupuytren’s contracture from developing or worsening.
Fortunately, the vast majority of patients with Dupuytren’s do not experience significant pain accompanying the loss of motion. For patients who do experience discomfort, we often encourage them to take non-steroidal anti-inflammatory medication as needed. Of course, other treatments are often necessary to return more significant function and mobility to the hand and fingers.
What treatment options are there for Dupuytren’s contracture?
While Dupuytren’s is not curable, treatment options continue to improve for patients with the condition. Today, several nonsurgical and surgical treatments are available. We tailor our treatment recommendations based on patient preferences, goals, activity level, medical history, and a clinical exam.
Patients with early-stage contractures affecting a single finger may choose to receive an injection or other minimally invasive treatment with a quicker recovery. Those with advanced or complex contractures affecting multiple fingers and the joints may prioritize maximizing their overall function with more extensive surgery.
What nonsurgical treatments are available?
One treatment option is an injection in the hand. The medication is a type of activated enzyme that can break down the type of protein — like collagen — involved in the connective tissue contractures seen in Dupuytren’s. Studies have shown that this approach can have a very good success rate in some patients. This success depends on numerous factors, including how early the condition is detected.
What are the surgery options for Dupuytren’s contracture?
There are several office-based or outpatient surgical options. The most common ones our patients have found success with are needle fasciotomies and partial fasciectomies.
- Needle fasciotomy: This simple treatment can be done while the patient is awake. The patient’s finger is first injected with a numbing medication. Next, a small needle is placed underneath the skin to cut the Dupuytren’s contracture cord in several places. The physician then slowly stretches out the finger to improve the motion.
- Partial fasciectomy: In this outpatient surgery, the surgeon uses a special zigzag incision to expose the Dupuytren’s contracture cord and damaged connective tissue. The surgeon then uses a microscope to meticulously remove the most problematic tissue. A version of this surgery involves removing both the connective tissue and the overlying skin. This is considered a more extensive way to address the problematic connective tissue. Since studies indicate similar success rates with either of these approaches, we weigh the patient’s goals and severity of their symptoms to guide the best path forward.
In general, the less-invasive treatment may provide a quicker recovery but may result in an earlier recurrence of symptoms. At the same time, the more extensive approach may result in a longer recovery but may provide a longer period before symptoms recur.
What are the keys to a successful recovery after surgery?
Since Depuytren’s contracture isn’t curable, gaining back your function after surgery is crucial to maximizing your quality of life. I typically recommend intermittent splinting after surgery to help improve the function of the involved fingers. However, it may not prevent the recurrence of symptoms. Hand therapy — occupational therapy — is very important after surgery to maximize our success. There is a variety of stretching and strengthening exercises to improve range of motion, dexterity, and function.
Depuytren’s contracture can significantly affect your quality of life and hand function if left untreated. But with a variety of interventions and ongoing management based on your healthcare provider’s advice, you can effectively treat Depuytren’s contracture and maintain your quality of life.
For more information or to schedule a consultation, please get in touch with Dr. Jarrett at Wilmington Health. Our orthopaedic team is dedicated to the care and support you need for hand mobility.