Surgical Information – Procedures

Treatment for Dupuytren's Contracture

What are the treatment options for Dupuytren's contracture?

Dupuytren's contracture, a thickening of the fibrous tissue layer underneath the skin of the palm and fingers, causes nodules and cords (rope-like structures) to form in the tissue. As the nodules and cords grow bigger, they can cause the fingers to curl in toward the palm.

Treatment involves removing or breaking apart the cords. Both surgical and non-surgical options are available and include:

  • Enzyme Injection. Xiaflex® is an enzyme injection that dissolves collagen, the principle component of Dupuytren's cords. The procedure is performed in the surgeon's office, by doctors specially trained in the technique. The surgeon injects the enzyme directly into the diseased tissue. The next day the patient returns to the office and the surgeon manipulates the cord to break it, allowing the finger to straighten. There is very little pain and swelling and most patients are able to return to work and daily activities immediately. Patients whose cords are prominent and palpable are good candidates.
  • Open surgery. The surgeon makes an incision over the cord and the diseased tissue is divided or removed to help restore finger motion. The main advantage to surgery is that it results in a more complete joint release than that provided by the needle or enzyme methods. However, recovery time can be long and require months of physical therapy.

The choice of procedure depends on the severity of symptoms. It is important that each patient is carefully screened by an orthopaedic surgeon to determine the most appropriate option.

Anatomy

Dupuytren's contracture affects the palmar fascia, a reinforcing mesh that lies just beneath the skin of the palm. Dupuytren's causes this fascia to thicken and shrink, which pulls the fingers down into a bent position. Areas that are actively shrinking, called nodules, feel like calluses. Eventually, cords form that feel like strings under the skin

When is surgery recommended?

Dupuytren's contracture usually progresses very slowly and may not become troublesome for years. In some cases, corticosteroid injections can help relieve pain and prevent progression of the disease.

If the condition continues to get worse and your hand function is severely limited – you have trouble grasping objects, holding your hand flat or pushing yourself up, for example – a more progressive treatment option is recommended.

Depending on your symptoms, you may be a candidate for enzyme injection or open surgery. Commonwealth hand surgeons screen each patient carefully to determine the best course of action.

What is the recovery time?

Recovery varies by patient and treatment method. Patients who have an enzyme injection usually experience little to no pain and are able to return to work and activities right away. For those who have open surgery, recovery time is longer. People usually require several months of physical therapy after surgery for Dupuytren's contracture.