Dupuytren's contracture
What is Dupuytren's contracture?
Dupuytren's contracture is a condition in which the finger(s) of the hand curve inwards. The curvature is caused by thickening and shortening of the fibres that attach the skin of the palm to the strong connective membrane underneath. Since the fibres of the palm in question and the aponeurosis are connected to the tendons involved in flexing the fingers, the shortening also affects the position of the fingers. The lesion of the tendons is caused by an increase in the number of connective tissue cells that make up the tendons, producing large amounts of collagen. At first, knots or nodules form in the connective membrane, which are arranged in the direction of the fingers. These nodules do not initially cause any symptoms, but may only cause pressure sensitivity when grasped. Later, the extension of the affected fingers is limited. In the final stage, the fingers are locked into a curled constraint, this means that the patient is unable to straighten his or her fingers. Contracture makes it difficult to carry out everyday activities such as driving, holding hands, playing sports, holding objects.
Investigation: Hand surgeon specialist or orthopaedic-traumatologist specialist
Therapy: specialist in hand surgery, orthopaedic-traumatologist specialist, physiotherapist-physiotherapist
Reasons for its development
The course of the disease is progressive, worsening over time, unfortunately more rapidly in younger patients, but with spontaneous improvement in about 10% of patients. A Dupuytren's contracture is not fully understood at the current state of medical science, but the hereditary predisposition plays a big role included. In the early stages, cautious waiting is allowed, with regular medical check-ups. If the function of the finger joints deteriorates further and the constraint worsens, surgery is indicated. From the third day after the operation, you can start exercising the unaffected joints, and slowly you can start active exercise of the affected joints. Permanent healing can be achieved with surgery.
Resolution of Dupuytren's contracture with minimally invasive surgery
What can we do after the injectio treatment is no longer available?
A Dupuytren's contracture without surgery, we previously had an injection containing a „fibre-dissolving” enzyme, Xiapex. Unfortunately, the company withdrew from the whole of Europe, making the product unavailable.
In addition to the extended surgery, there is a procedure under local anaesthesia for the treatment of palmar tuberosity, which can achieve similar results to the injections. During the procedure, an anaesthetic is applied to the skin of the palm and then a thick, strong needle is used to cut away the tight bundles, improving the range of motion of the fingers. After the procedure, as before after the injections, the scarred skin remains in the palm, but by cutting the bundles in the right place, the finger can be stretched. This so-called needle aponeurotomy is performed in an operating theatre as part of a day surgery. The next day, we perform a dressing change, wound and function check. As only small puncture wounds are made on the hand, wound healing takes a few days and the hand is back in use very quickly.
The procedure can be performed as a stand-alone operation or, in the case of advanced disease, as a preparation for surgery to remove the entire lining.
Complications may include subcutaneous haematoma, tendon, blood vessel or nerve damage. The risk of these can be minimised with careful surgical technique.
Although needle aponeurotomy is not equivalent to Xiapex injectios, it may be a suitable alternative for those who want a quick movement correction instead of an extended surgical solution.
Our hand surgeons
Dr. János Bartha
Orthopaedic-traumatologist, robotic surgeon
