Hand pain is one of the annoying pains that can affect you in an unforgivable way. One of the causes of hand pain that affects function is Dupuytren’s contracture. Also known as Dupuytren’s disease, Dupuytren’s contracture is a condition in which the skin in the palm of the hand thickens abnormally at the base of the fingers. This thickened area may develop into a hard lump or thick band. Over time, one or more fingers may curl (contract), pull sideways, or pull in toward the palm as a result.
The ring and little fingers are the most affected by Dupuytren’s contracture. It is possible to have it in both hands at the same time. It usually worsens over a period of months or years. In the early stages, treatment is usually ineffective.
Causes of Dupuytren’s Contracture
The exact cause is unknown, but Dupuytren’s contracture has been linked to:
- Having a family history of the condition
- Drinking excessive alcohol
- Having diabetes or epilepsy
The severity of your Dupuytren’s contracture will affect the treatment options that will best suit you. Your doctor will discuss the best treatment options for you after a thorough evaluation. These options will depend on the stage and pattern of your disease, the impact it is having in your daily activities, and your overall health.
The cords that are pulling your fingers toward the palm are removed or broken apart as part of treatment. This can be done in several ways.
Nonsurgical treatments for Dupuytren’s contracture include:
- Stretching This may be recommended for the mildest forms of Dupuytren’s disease, according to experts. Stretching can also be used in conjunction with other treatments. Any stretching program should be discussed with your doctor.
- Steroid Injections When injected into a Dupuytren’s nodule, these strong anti-inflammatory medications may be beneficial. However, multiple injections are frequently required. Steroid injections can help reduce the size of nodules early on in the disease’s progression, but they’re less effective as the disease progresses and thickened tissue forms. It may also help slow the progression of the disease, but it won’t help you straighten your finger if you already have a contracture.
- Enzyme Injections A type of enzyme can be injected into the taut cord in your palm, softening and weakening it, allowing your doctor to manipulate your hand later in an attempt to break the cord and straighten your fingers. Collagenase clostridium histolyticum (Xiaflex) has been approved by the FDA for this purpose. The advantages and disadvantages of the enzyme injection are similar to needling.
- Needling This technique uses a needle, inserted through the skin, to puncture and break the cord of tissue that’s contracting a finger. Contractures often recur but the procedure can be repeated. The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. The main disadvantage is that it can’t be used in certain places in the finger, because it could damage a nerve or tendon.
If the contracture interferes with hand function, your doctor may recommend surgical treatment. The goal of surgery is to reduce the contracture and improve motion in the affected fingers.
The surgical procedures most commonly performed for Dupuytren’s contracture are fasciotomy and subtotal palmar fasciectomy. Your doctor will speak with you about which procedure is best in your situation.
- Fasciotomy Your doctor will make an incision in the palm and divide the thickened cord(s) of tissue during this procedure. Although the cord is not removed, dividing it aids in the reduction of contracture and the increase of movement in the affected finger. A local anesthetic is used to numb your hand during the fasciotomy. Your wound will be left open after the procedure and allowed to heal naturally. You will have to wear a splint during recovery.
- Subtotal palmar fasciectomy In this procedure, in order to straighten your finger, your doctor will make an incision and remove as much abnormal tissue and cord(s) as possible. A fasciectomy can be performed with a variety of incisions, but the most common is a “zig-zag” incision made along the natural creases in the hand. After fasciectomy, your wound may be left open to heal on its own. In some cases, a skin graft is required to aid wound healing. Your doctor will use healthy skin from another part of your body to seal the wound during the skin graft. During your recovery, you may need to wear a splint. Subtotal palmar fasciectomy is a more involved procedure than fasciotomy, requiring more wound care and physical therapy, as well as a longer recovery time and more patient effort.
Hand Specialist in North Dakota
Here at The Bone & Joint Center, we have hand specialists on our team who can diagnose and treat your condition, restoring your hand strength and function. We have locations across North Dakota for your convenience.
If you have any questions or would like to make an appointment, contact our friendly staff today by calling us at (800) 424-2663 or by filling out our convenient online form. We look forward to helping you find long-term relief from your hand pain!