Dupuytren's contracture

Dupuytren's contracture after surgery is one of the most common condition we see in our hand clinic. We have years of experience treating this disease and thanks to our expertise and facilities our clients have usually very good outcomes. You can read through our concise guide to Dupuytren's contracture on this page including the treatment options in our clinic. 

You can also visit the International Dupuytren Society website for more information

What is Dupuytren's contracture?

Dupuytren's contracture is a disease affecting fascia usually in the palm of hand. Palmar fascia, also called palmar aponeurosis,  is connective tissue that lies under the skin of palm and fingers. Its function is to stabilise the skin of the palm to improve grip and to protect underlying issues. You can find out more about this structure here.

In Dupuytren's disease the bands in the palmar fascia thicken and tighten and that can pull the fingers into the palm. The exact cause is not known but it tends to run in families and there is some evidence that cigarettes smoking, excess consumption of alcohol, diabetes and medication to treat seizures could  be contributing factors. It is more common in men than women and the conditions usually starts after 45 years of age.

What are the symptoms of Dupuytren's disease?

The symptoms of Dupuytren's disease are:

  • at the start small nodules in the palm of your hand, they can be tender but usually the tenderness goes away over time
  • as the disease progresses the nodules  thicken and turn into cords, there could be groves next to the cords in the palm 
  • cords can tighten further and pull the fingers into the palm causing contracture of the fingers

One or more fingers can be affected, most commonly it is the small and ring finger. However all fingers can be affected including the thumb. Sometimes the disease progresses fast and the finger can start pulling in within weeks or months of the first nodules appearing, other times it can take several months or years for the fingers to contract. In some people the disease never progresses from the first stages when only the nodules are present. 

 

Treatment of Dupuytren's contracture

Dupuytren's contracture can not be cured but there are treatments available to slow down the progression of the disease, and also treatments that help to decrease contracture and regain movement of the affected hand if the contracture starts interfering with the hand function.

 

• steroid injections - can help to ease the pain if the nodules are tender and it can possibly slow down the progression of the disease

• radiation therapy - low level X-ray radiation can help especially at the early stages of the disease. Click here to see the clinics offering radiation treatment for Dupuytren's disease

• enzyme injection - enzyme called collagenase is injected into the cord to weaken the structure allowing it to be broken and thus allowing the finger to straighten again. It is minimally invasive procedure and in Ireland it is performed by Consultant trauma and orthopaedic surgeon Mr Philip Grieves (Dublin and Belfast)

• needle aponeurotomy - also called needle cording or needle fasciotomy is a minimally invasive procedure often performed in the surgeon's office; it is suitable for less advanced disease. Click here for list of clinics performing the needle aponeurotomy 

• surgery - when the fingers are bent too far into the palm and limiting function; there are 3 main procedures that can be done to release the contracted fingers: fasciotomy (surgical release of fascia without removing the cord), fasciectomy (surgical removal of affected fascia including nodules and cords) and if the Dupuytren's contraction is too far progressed there is dermofasciectomy (surgery to remove affected fascia together with the affected skin - skin from arm or hip is grafted and used to cover the wound in the hand)

Hand therapy after Dupuytren's contracture surgery

Regardless of the procedure used to fix your Dupuytren's contracture you will need to see a hand therapist for splinting and rehabilitation to get the fingers moving again. The after surgery care will depend on your surgeon's protocol but in general it follow this path:

  1. A cast or slab is applied in the operating theatre to protect your hand and this is usually removed at the first dressing change appointment about 1 week after the surgery - you will usually see the nurse specialist who will inspect your wound to make sure everything is healing well and she will put new dressing on. You will be sent to a hand therapist for splinting; the thermoplastic splint is usually worn at night for between 6 weeks and 12 weeks as advised by your surgeon. The role of the splint is to keep the fingers straight (your fingers will naturally curl in when resting, the splint will prevent that from happening). You will be also advised to wear the splint during the day for certain activities that could  damage the healing wound. You will be also advised to wear the splint 24/7 if advised by your surgeon after grafting.
  2. After the first dressing you might be also referred to a hand therapist to start  the rehabilitation. In the Perfect Therapy  clinic the first appointment usually involves: manufacturing of the splint, swelling / oedema management and gentle range of motion is started if appropriate. The treatment plan will be also discussed with you and further visits planned - once or twice weekly visits are usually needed to ensure good progress.
  3. After 10 -21 days depending on the healing progress the sutures are removed - you might be called to see the specialist nurse few times before the stitches come out if they feel the wound needs regular check-up
  4. After the stitches are removed the more intense rehabilitation can start. Our goals are:
  • to reduce the swelling
  • to regain the range of movement in all fingers (wrist, elbow and shoulder)
  • to prevent scar tissue adhesions, tightness and fibrosis

The treatment in our clinic will usually include:

  • splinting
  • icing  and later hydrotherapy (once the wound is fully closed)
  • myofascial work on your forearm, wrist and hand
  • gradually progressing range of movement exercises (respecting the wound healing stage) and strengthening
  • mobilisation of the wrist and finger joints 
  • scar therapy
  • functional activities and advise on return to work / sport / leisure activities

 

10 days after the  surgery

6 weeks after the surgery