What is Dupuytren’s Contracture?
Dupuytren’s contracture is a hand deformity in which the fibrous tissue of your palm covering the finger tendons abnormally thickens and pulls the affected digits into a “curled” position. The condition typically affects your ring and little fingers while sparing your forefinger and thumb.
What Causes Dupuytren’s Contracture?
We do not know for sure what triggers the condition. However, Dr. Scott D. Ruhlman highlights a few common risk factors, such as:
- Gender: Men are three times as likely to develop the disease and tend to have more severe disease
- Age: The disease is more common in middle-aged people
- Alcohol use: Drinking alcohol can lead to Dupuytren’s
- Heredity: The condition is associated with certain genes and runs in families
- Medical conditions especially diabetes and seizure disorder
How to know if you have Dupuytren’s Contracture?
The deformity usually starts as knots (lumps or nodules) in the skin of your palm, which gradually evolve into thick cords. These cords then spread into your fingers, causing them to bend completely over time. You may also experience some tenderness and discomfort along with the nodules, but these usually fade out.
When you present with such symptoms, your hand is inspected for dimples, thickened skin, curved fingers, and lumps (nodules). Dr. Ruhlman then performs a tabletop test to confirm the diagnosis. This test requires you to place the palm of your hand flat on a table. Inability to flatten your hand is indicative of Dupuytren’s contracture.
How do you treat the Deformity?
If a Dupuytren’s contracture is worsening, it will interfere with hand function and daily activities. In such scenarios, Dr. Ruhlman recommends certain nonsurgical and surgical treatments to prevent the disease from getting worse and thus improve your hand function.
These treatment options include:
Needle aponeurotomy
It’s an effective, minimally invasive office procedure that safely treats multiple hand joints and fingers in one session. It’s more cost-effective and has fewer risks compared to other available options. On the flip side, recurrence rates are higher in contrast to open surgery and Xiaflex (collagenase) injections.
During needle aponeurotomy, the affected hand is first numbed with a local anesthetic. A needle attached to a syringe is then passed using a to-and-fro motion through the diseased tissue to weaken and rupture it. This helps elongate the contracted tissue.
Enzyme injections
Xiaflex is an enzyme called collagenase that breaks down the collagen in the diseased cords. It is injected into the Dupuytren’s cord to weaken and dissolve it. The affected hand is then manipulated the next day after the injection to break up the cord.
The limitations are that Xiaflex is a single-site injection, and, therefore addressing multiple hand joints requires several sessions, separated by an interval of least 4 weeks. There’s also a high recurrence of the problematic scar bands.
Open surgery (fasciectomy)
This procedure involves removing the restrictive cord (s) after making an incision along your hand’s creases. It helps fix the deformity in a great majority of patients. However, surgery is not a definitive cure for the disease. Moreover, the recovery time is longer and mandates physical therapy to restore your hand’s complete movement.
Occasionally, it may not be possible to remove the cord unless the overlying skin is detached. That said, having your surgery performed by a skilled hand surgeon like Dr. Ruhlman can help stave off, or at least, minimize the risk of skin loss as well as any other major complication.
Dr. Ruhlman offers the highest quality specialty care of your hand, shoulder and elbow conditions. Please contact Orthopedic Specialists of Seattle to set up an appointment today.
