Treatment for Dupuytren's contracture depends on the severity of your condition. Over the course of Dupuytren's disease, fibrous tissue in the palm thickens and tightens. This causes one or more fingers to progressively stiffen, bend, and lose flexibility.
As the condition progresses, your doctor may suggest nonsurgical and surgical types of treatment for your Dupuytren's contracture.
The goal of treatment for Dupuytren’s is to reduce the symptoms and disability caused by the disease. At this time, however, there is no treatment to stop Dupuytren's contracture from getting worse.
In some people, the condition may progress slowly and it may never become worse than a bit of lumpiness in the palm of your hand. A simple wait and see approach may be all that is necessary if your Dupuytren’s is mild and does not affect your daily life.
For more progressive cases, your doctor will discuss the best treatment options for you. These will depend on the stage and pattern of your disease, the impact it is having in your daily activities, and your overall health.
Nonsurgical Treatment for Dupuytren's Contracture
Nonsurgical treatments are often recommended at early stages of Dupuytren's or in addition to surgery. While many nonsurgical treatments have been studied, only a small number have shown a benefit.
Experts may recommend stretching for the mildest forms of Dupuytren’s. In addition, stretching may be used along with other treatments. It’s important to work with your doctor on any stretching program.
These strong anti-inflammatory medications, when injected into a Dupuytren’s nodule, may be helpful. Often, however, multiple injections are necessary. Steroid injections may reduce the size of nodules early in the course of disease but are less effective in the later stages of Dupuytren’s when more thickened tissue has formed. Steroid injections may help slow progression of the condition but won't help straighten your finger if you already have a contracture.
If your finger is already bent, your doctor may recommend Xiaflex, a mixture of enzymes that is injected into the affected area to break up the tough tissue. The drug loosens the tissue. If the contracture is still present on the following day, your doctor will stretch your finger and try to straighten it. The injections are given in the doctor’s office and may be used as an alternative to surgery. Your doctor will also recommend certain stretching exercises after the injections.
Most people need one or two injections in the affected joint, but some people may need up to three injections to straighten or nearly straighten the finger. The most common side effects are swelling in the affected area or bleeding, bruising, and pain at the injection site. Rarely, more serious side effects, such as damage to a tendon, nerve injury, or allergic reaction may occur.
Another option for treatment is low energy radiation therapy. It can help symptoms and prevent worsening of the the cords, nodules, and skin changes that can come with Dupuytren's contractures.
Surgery for Dupuytren's Contracture
What if it becomes difficult for you to grasp objects or perform other daily activities? Your health care provider may recommend surgery if your disease progresses. The goal of surgery is to restore motion in your fingers.
The surgeon makes an incision and either divides (fasciotomy) or removes (fasciectomy) part or all of the thickened bands of tissue.
A variety of techniques are used to close the wound. Sometimes a skin graft is needed for the incision to completely heal. To do this, the surgeon takes healthy skin from another area of the body and attaches it to the area in the hand that needs to be closed.
An alternative to open surgery is an office procedure called needle aponeurotomy. The surgeon uses a hypodermic needle to divide and cut the diseased tissue in the palm and fingers.
This procedure is less invasive and leads to a quicker recovery than open surgery. Many do not need rehabilitation with physical therapy following the procedure. A presurgical evaluation can determine whether you are a candidate for this procedure.
What to Expect After Surgery
Surgery may be able to correct the changes of Dupuytren’s if only one of the knuckles connecting the finger to the hand is involved.
If two or more fingers are involved in this joint, it is more difficult to correct the contraction. For other joints of the fingers, surgery may improve but not correct the limitations caused by this disease.
Both open surgery and needle aponeurotomy have a high rate of recurrence of contractures. Also, open surgery can lead to an exaggerated reaction to the wound.
Other complications of surgery include:
- Swelling and soreness
- Injury to nerves or blood vessels
- Tissue death
After surgery, it may help to elevate your hand above your heart and gently move your fingers. This may help relieve pain, swelling, and stiffness.
Your doctor may refer you to a physical therapist. Your therapist can teach you exercises to improve strength and function and improve your healing.
Some surgeons may recommend a hand splint to aid comfort and improve the position and function of your fingers. Splinting, however, is not always beneficial.
You will be encouraged to return to your activities as soon as you can.