Dupuytren’s Contracture

The treatment of Dupuytren’s contracture by our hand surgeon can involve both non-surgical and surgical interventions, depending on the severity and progression of the condition. Here is an overview of the treatment options commonly employed by hand surgeons for Dupuytren’s contracture:

1. Non-Surgical Treatments:
   • Non-surgical treatments are typically considered in the early stages of Dupuytren’s contracture when the symptoms are mild or the contracture is not significantly affecting hand function.
   • Observation: In some cases, the hand surgeon may adopt a “watch and wait” approach, monitoring the progression of the contracture without immediate intervention.
   • Hand Therapy: Hand therapists can provide exercises and stretching techniques to maintain hand mobility and prevent further contracture. They may also use techniques such as heat therapy and ultrasound to help manage symptoms.
2. Collagenase Injections:
   • Collagenase injections, such as Xiaflex, have emerged as a non-surgical treatment option for Dupuytren’s contracture.
   • The hand surgeon injects the collagenase medication into the cord of tissue causing the contracture. The medication works by breaking down the collagen, thereby weakening and softening the tissue, which allows for manual manipulation of the finger to straighten it.
   • This procedure is typically performed in the surgeon’s office, and multiple injections may be required over a series of weeks.
3. Surgical Intervention (Fasciectomy or Fasciotomy):
   • Surgical intervention is often considered when Dupuytren’s contracture progresses to a point where hand function is significantly affected or if non-surgical treatments are unsuccessful.
   • Fasciectomy: In this surgical procedure, the hand surgeon removes the affected tissue (palmar fascia) causing the contracture. Depending on the severity and extent of the contracture, the surgeon may perform a partial fasciectomy or a complete fasciectomy.
   • Fasciotomy: This procedure involves making small incisions in the contracted tissue to release the tension and allow the finger to straighten. Fasciotomy is typically performed in less severe cases or when the contracture affects only a small portion of the palm or finger.
   • After the surgery, hand therapy is often recommended to aid in the recovery process, restore hand function, and prevent post-operative complications.

It’s important to note that the choice of treatment depends on several factors, including the severity and progression of the contracture, the involvement of other structures in the hand and individual patient characteristics.

Dupuytren’s contracture is a progressive condition, and while treatments can help manage the symptoms and improve hand function, there is a potential for recurrence over time. Regular follow-up with a hand surgeon is important to monitor the condition and determine the need for additional interventions if necessary.