Understanding Dupuytren's Contracture
Dupuytren's Contracture Treatment
If Dupuytren's contracture isn't bothering you much, you shouldn't need treatment. However, if Dupuytren's is interfering with your daily activities, your doctor may recommend one of these treatments:
- Stretching exercises for very mild cases
- Steroid injections to help bring down inflammation and possibly slow the course of the disease, but they don't actually straighten your finger
If your fingers are already bent, collagenase (Xiaflex), a mixture of enzymes that help dissolve the tough tissue, may be injected into the affected area by your doctor. This weakens the tight bands and may allow your doctor to then stretch the tightened area and straighten your finger. 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.
When surgery is called for, the surgeon performs a fasciotomy in which tissue from the palm is removed through an incision. Then the open wound is allowed to heal on its own, or it is covered with a skin graft taken from another part of your body. The hand is often splinted after surgery to help with healing.
Surgery for Dupuytren's can have risks, including:
- Damage to nerves and blood vessels in the affected fingers
- Permanent stiffness in the fingers
It can take two months or more to fully return to your normal activities after surgery. Try to keep moving your fingers to relieve pain and stiffness. Massaging your fingers or applying heat can also help with movement and discomfort. A physical therapist can teach you exercises to help you regain the motion in your hand.
Dupuytren's contracture eventually comes back in up to half of people who have surgery. If the thickened tissue develops again, you might need another procedure.
A less invasive Dupuytren's contracture treatment that some surgeons are now using is called needle aponeurotomy, formerly known as needle fasciotomy. This procedure is done in the doctor's office using local anesthesia. The surgeon uses a needle to split the bands of tissue.
Because the technique doesn't use open cuts, there is less risk of infection and injury, and recovery is usually quicker than with open surgery. However, the surgeon has to be very specialized to perform a needle aponeurotomy. And because this procedure is still relatively new, doctors still aren't sure of the long-term outcome.