Dupuytren’s Contracture

Dupuytren’s contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening of this fibrous tissue can cause the fingers to curl inward.

The cause of Dupuytren’s contracture is primarily genetic predisposition. It is most common in people of Northern European (English, Irish, Scottish, French, Dutch) or Scandinavian (Swedish, Norwegian, or Finnish) ancestry, and often runs in families. Other factors that put people at risk for developing the condition include drinking alcohol and certain medical conditions, such as diabetes and seizures.

Dupuytren’s contracture symptoms usually occur very gradually and include one or more small, tender lumps (nodules) in the palm. The nodules may thicken and contract, forming tough bands of tissue under the skin. In addition, one or more fingers bend in toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may be hard to straighten.

There is no way to stop or cure Dupuytren’s contracture. However, it is not dangerous. The condition usually progresses very slowly and may not become troublesome for years.

NONSURGICAL TREATMENT

If the condition progresses, nonsurgical treatment may help to slow the disease.

If a lump is painful, Dr. Pianka can administer an injection of corticosteroid – a powerful anti-inflammatory medication – to help relieve the pain. In some cases, it may slow the progression of contracture.

It should be noted that splinting does not prevent the finger from bending further. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.

Surgical Treatment

Surgery is recommended when your doctor has confirmed through measurements over time that the disease is progressing. You may also decide to have surgical treatment when your hand function is so limited that you have trouble with simple functions such as grasping objects, putting your hands in your pockets, or shaking hands.

Treatment for this condition previously required extensive surgery, but Dr. Pianka offers a new alternative called a needle aponeurotomy, which is a minimally invasive procedure performed in his office. After numbing the hand with a local anesthetic injection, Dr. Pianka uses a hypodermic needle to divide the knotted tissue in the palm through microscopic puncture wounds. No incision is required, and complications are no greater than with surgery. In fact, patients experience less pain and swelling immediately after the procedure, and there is a quicker recovery time as well as less scarring. Patients can return to light work activities immediately. Strenuous work, sports, or hobbies can be resumed after a week, and no physical therapy is needed.

Dr. Pianka also uses a recent Federal Drug Administration-approved enzyme injection to treat Dupuytren’s contracture. The enzyme is able to break down the tough bands and improve motion without surgery. After numbing the hand with a local anesthetic injection, Dr. Pianka injects the enzyme directly into the diseased tissue. During the several hours following the injection, the enzyme dissolves the contractile tissue, allowing the finger to straighten. The procedure is performed in the doctor’s office, and is associated with less pain and swelling than with surgery.

 

1) Patient with Dupuytren’s contrature and 2) after a needle aponeurotomy.