Dupuytren's contracture
Treatment for Dupuytren's contracture (Dupuytren's disease) is usually only required ifthe condition affects the function of your hand. Many cases are mild anddon't need to betreated.
The treatment used largely depends on the severity of the condition. In milder cases thatrequire treatment, non-surgical treatments or a minor procedure called aneedle fasciotomy may be recommended.
Formore severe cases, surgery is an effective and widely used treatment. The two most common surgical proceduresare an open fasciotomy and a fasciectomy.
These treatments are described in more detail below.
Non-surgical treatment options for Dupuytren's contracture may include radiation therapy and a medicine called collagenase clostridium histolyticum. These are generally most effective if used before the condition becomes severe.
In 2010, the National Institute for Health and Care Excellence (NICE) issued guidance about the use of radiation therapy to treat Dupuytrens contracture . Radiation therapy aims to prevent or delay the need for surgery.
Radiation therapy involves aimingcontrolled doses of high-energy radiation (usually X-rays) at the nodules and cords in your hand.
The radiation doses arespread over several consecutive days. After a few weeks, the treatment can be repeated, if necessary.
It's not known exactly how radiation therapy works, but it's thought the radiation affects the development and growth rate of fibroblasts in your hand. Fibroblasts are cells that produce and release collagen (the protein that forms the main part of the bodys connective tissue).
In one of the studies reviewed by NICE, the symptoms of Dupuytrens contracture had improved in over half of the hands that were treated after one year. In another long-term study, two-thirds of people had some degree of symptom relief after 13 years.
Possible side effects of radiation therapy include dry skin, flaky skin and slight thinning of the skin.
Radiation therapy may not be suitable for everyone with Dupuytren's contracture. If you're offered radiation therapy, you should be aware of the uncertainty about its effectiveness and the possible although very small long-term risk that radiation may cause cancerous tumours.
Collagenase clostridium histolyticum is a medicine that can be injected into cords in the palm of your hand. The medicine contains special proteins that can weaken the cords.
After having the injection, you'll be monitored for around half an hour and then you can go home. You return to your doctor 24 hours later and they'll straighten your bent finger and stretch it out for 10 to 20 seconds. This breaks the cord and should help to increase the range of movement in your bent finger.
Don't attempt to straighten your finger yourself within the first 24 hours, or squeeze or press the cord. Keeping your finger bent encourages the injected medicine to stay in the cord, which is where it needs to be.It alsohelps to keep the hand elevated to reduce swelling and prevent the medication leaking out.
If the first injection isn't effective, you can have up to three injections in the same cord, with one month between each injection.
The most common side effects occur around the site of the injection and include:
These should improve within a week or two. Less common side effects include feeling sick or dizzy.
As with radiation therapy, the long-term effects of collagenase clostridium histolyticum are unknown. It may also not be widely available.
A needle fasciotomy is also known as a needle aponeurotomy or a percutaneous needle fasciotomy (percutaneous means "performed through the skin").
It's usually performed as an outpatient procedure, meaning you won't need to be admitted to hospital. You'll be given a Local anaesthetic to numb your hand without making you lose consciousness.
During the procedure, a sharp blade or a very fine needle will be inserted into the fibrous bands in the palm of yourhand or your fingers. The blade or needle will be used todividethe cord under your skin.
Bydividing the thickened tissue, your surgeon will release the tightness in your hand that's forcing your finger to bend. The benefits of needle fasciotomy include:
However, the rate of recurrence for Dupuytrens contracture is very high: as many as 60% of people who have a needle fasciotomy experience Dupuytrens contracture again within three to five years.
An open fasciotomy is sometimes used to treat more severe cases of Dupuytren's contracture. The procedure is more effective in the long term than a needle fasciotomy, but it's also a more extensive operation and carries some additional risks (see below).
Like a needle fasciotomy, an open fasciotomy will be carried out as an outpatient procedure under local anaesthetic. The surgeon will make an incision in the skin of your hand, so they can gain access to the connective tissue underneath. They'll then cut the thickened connective tissue to divide it up, allowing you to straighten your fingers.
After the surgery has finished, the cut on your hand is sealed with stitches and a dressing is applied. The recovery time for an open fasciotomy is slightly longer than that of a needle fasciotomy, because the wound will need time to heal.
Following the procedure, it's likely that you'll need to make another appointment to have your stitches removed, and you may be left with a small scar.
A fasciectomy involves removing the thickened connective tissue. There are three variations of the procedure:
A fasciectomy is usually carried out under general anaesthetic . This means you'll be unconscious throughout the procedure and unable to feel pain. In some cases, regional anaesthetic may be used. This is where local anaesthetic is injected into the nerves near your neck, to numb your whole arm, but you remain conscious.
During the procedure, an incision will be made in your hand and the affected connective tissue will be removed. If it's necessary to seal the wound using a skin graft, your surgeon will take a graft from an area of your body that's usually covered by clothing, such as your upper arm, the front side of your elbow or your groin.
A fasciectomy is a more extensive operation than a fasciotomy, so the risk of complications is slightly higher, at around 5% (see below). However, the results are longer-lasting. For example, the rate of recurrence of Dupuytrens contracture following dermofasciectomy may be as low as 8%.
Read about plastic surgery techniques for more information on skin grafts.
If your surgery is complex and extensive, your risk of developing complications will be greater than if you have a more minor procedure.
For needle fasciotomy, the rate of complications is low, at around 1%. For fasciectomy, studies have found complication rates to be higher, from around 5%. Some possible complications include:
Discuss the risks of the surgical procedures used to treat Dupuytrens contracture with your surgeon.
.
Read about Dupuytrens contracture (Dupuytren's disease), whichaffects the hands and fingers and causes one or more fingers to bend into the palm of the hand.
The first symptom of Dupuytren's contracture (Dupuytren's disease) is usually the growth of small lumps of tissue called nodules on the palm of your hand.
Dupuytren's contracture (Dupuytren's disease) occurs when cords of shortened connective tissue prevent you from fully extending your finger.
See your GP if you think you have Dupuytren's contracture (Dupuytren's disease). The first step is to examine your palm and hand for signs of the condition.
Treatment for Dupuytren's contracture (Dupuytren's disease) is usually only required if the condition affects the function of your hand. Many cases are mild and don't need to be treated.
Recovering full or partial function of the hand following hand surgery for Dupuytrens contracture can take a long time.