DUPUYTREN'S CONTRACTURE

 
 

What is it?

A condition where one or more fingers become permanently bent in a fixed flexed position due to fibrous tissue that forms along the palmar fascia of the hand. It often starts as hard nodules in the palm area and worsens with time, making it impossible for the involved fingers to straighten completely.

Is it an indication of another underlying condition?

Although the cause to this condition is unknown, it has been found that those with Diabetes Mellitus, liver disease, thyroid disorders and individuals with a history of high alcohol consumption and/or smoking are more at risk for developing Dupuytren's.

Additionally, there is a small percentage of individuals with genetic conditions and those with prior hand injuries that are predisposed to developing Dupuytren's contracture.

 

What is the management?

Depending on the severity of your contracture, it can be managed conservatively or non-conservatively. If you present very early on and there is limited contracture, it is possible to manage the condition with a combination of steroid injections and physical therapy. With more advanced presentations, contractures can be managed with collagenase injections and needle fasciotomies  or surgical excisions of the fibrous tissue.

What does surgical excision entail?

If contracture is severe, surgical excision of the fibrous cords is performed.  A zigzag incision is made along the strand/cord that is preventing the affected finger from completely extending and the fibrous bands are then excised from the palm of your hand. Once these bands are removed, you will be able to straighten the affected finger again. 

Alternatives to surgical Management?

Surgery to correct Dupuytren’s contracture can often be quite debilitating with a long recovery process. An alternative to this would be to use an enzyme collagenase with needle fasciotomy to open up the contracture.

However, collagenase treatment is not covered by OHIP and needs to be purchased directly from the pharmaceutical company. Individuals with private health insurance are encouraged to contact their insurance company to see if collagenase injections are covered under their plain.

 
 

What does collagenase and needle fasciotomy entail?

Collagenase is an enzyme that is injected into the affected fibrous sheath which functions to break down the thickened cords and tissue that is preventing the affected fingers from full extension (making your finger straight). Several days after the collagenase injection, after giving adequate time for the enzymes to work, you will return to the clinic where moderated pressure is applied to open the area that is contracted down. Sometimes a needle is used to help break up  any additional cords through the skin to help you straighten your fingers as much as possible.

What happens if I delay the surgery?

If you chose not to have surgery or any type of intervention, your contracture and cords may:

  1. remain the same in terms of the size of the cord and the degree of contracture, or

  2. worsen with enlargement of the cords and increasing in the contracture resulting in further limitations to the range of motion in the affected finger.

 
 

What are the chances my symptoms return after surgery?

The probably of recurrence or extension of disease to other fingers in Dupuytren's disease is unfortunately common. This is especially true for patients who develop the disease at a young age.

However the likelihood for repeat surgery at the same joint is low after the age of 50. Depending on the joint involved, the rate of recurrence varies as well. Contractures at joints closer to the palm reoccur less often when compared to joints that are closer to the tip of the finger. Recurrence at the site of previous surgery ranges from 8-54%.

 

How soon would you recommend that I have this surgery?

The need for surgery depends on the degree of interference you are experiencing with the contracture and limited range of motion. Surgery does not cure the disease but rather it corrects the limitations to the range of motion you are experiencing as a result of the disease.

Your surgeon will advise you as to whether you need surgical management or when conventional therapy is appropriate during your initial consultation. Please have your family doctor send a referral to Dr. Quinton Chivers’ office at the Canadian Plastic Surgery Centre. Our contact information can be found on the Contact Us page of this website.

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