Dupuytren’s

WHAT YOU SHOULD KNOW

Dupuytren’s contracture is a special disease that is transmitted genetically from Northern European ancestors. It causes the layer of tissue under the skin but above the tendons and joints to spontaneously contract slowly. Eventually the skin becomes attached and the joints become permanently flexed. No medications, therapy or splints can stop the process. Patients are counseled to follow periodically with an expert in hand surgery until advised that the condition has advanced enough to merit undergoing surgery. Treatment is reasonable to consider when one or more fingers have actually become stuck in a forward bent position that interferes with daily function. .

MEDICAL HISTORY

Patients often cannot even remember the number of years the nodules or cords of tissue have been present in the palm of the hand. They note progressive stiffness, mild pain grasping objects, and eventually loss of function in the hand.

EXAMINATION

The doctor will note each location of involvement including the degree of skin puckering or bonding and the measurement of each joint contracture.

ADDITIONAL TESTS

Plain x-rays will reveal any underlying arthritis in the affected joints that may make achieving good motion more difficult.

TREATMENT OPTIONS
  NO INCISIONS INCISIONS ONLY AS NEEDED
CONSISTS OF Needle used to disrupt contracted cord of tissue Surgical excision of the diseased tissue
FEATURES Abnormal tissue only separated but not removed Extent of incision depends on goals for removal of tissue
ADVANTAGES No incision More complete correction, less recurrence
DISADVANTAGES Less correction, faster recurrence More scar formation and trouble healing the surgical wounds
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Using a needle to disrupt the diseased tissue is called “percutaneous aponeurotomy”. Some doctors may offer another way to disrupt the diseased tissue, but only at one point with no actual removal of the diseased tissue by injecting a liquid enzyme “collagenase” into the hand. At best it only accomplishes the same as needle aponeurotomy but with several additional risks. The liquid enzyme can disrupt any body structure made out of the molecule collagen which is the main component of tendon, nerve, and skin. Complete tendon rupture has occurred with the use of collagenase injection. Also the manufacturer warns specifically about the need to be fully prepared to resuscitate a patient from anaphylactic shock (which can be fatal) as anaphylaxis could occur from collagenase injection. Since most of these injections would be given in a medical office building rather than a hospital, this may not be the safest practice for patients.

RECOVERY

Sutures are removed after 2 weeks in the office. Outpatient rehabilitation exercises are started immediately to regain motion. Use of the hands for everyday activities is encouraged right from the start. Wound healing issues, pain and swelling are very individual and determine how many weeks after is surgery is really practical for good hand use. Therapy continues for a period of several months until the motion achieved has been maximized. Splints to maintain the straight position are worn at night for up to 4-6 months after surgery.

Houston Hand and Wrist