Dupuytren’s Contracture
Dupuytren’s Contracture is a connective tissue disorder of the hand wherein the
fingers bend towards the palm and cannot be fully straightened.
What is Dupuytren’s Contracture?
Dupuytren’s Contracture is a connective tissue disorder of the hand’s palmar fascia wherein the fingers bend towards the palm and cannot be fully straightened. It is also known as Dupuytren’s Disease and is so named after Baron Guillaume Dupuytren, a surgeon who described an operation to correct this medical condition.
This affliction is jokingly referred to as Viking disease due to the high incidence rate among people of Scandinavian and North European descent. The disease usually shows up starting at age 40 with men acquiring the disease more often than women. It progresses slowly and almost always affect the ring finger as well as the little and middle fingers.
What are the signs and symptoms?
Dupuytren’s contracture initially affects the palmar fascia of the hand and causes the fingers to bend toward the palm. It usually is inherited or passed from generation to generation and is prevalent among people of European/Scandinavian ancestry.
The disease has a slow progression rate and people with this affliction have reported the following symptoms:
- Existence of a nodule/nodules in the palm that can either be painful or painless
- An increasing painless loss of range of motion of the affected fingers
- Aching and itchiness of the palm and affected fingers
- Abnormal thickening of the palm
- Finger joints are fixed and rigid
- Fingers begin to curl due to thickening of the palm
- Difficulty in holding or gripping objects in the affected hand
What are the possible treatment options for this medical condition?
Treatment starts once a patient tests positive on a simple procedure known as the Table Top test. A patient’s hand is placed on top of a table and if it lies completely flat on top then it is considered negative for the disease. If the hand cannot lie completely flat on the table then it is diagnosed as positive. Several treatment options can be availed depending on the severity of the condition:
1. Radiation Therapy
This is a minimally invasive technique. A small needle is inserted to weaken the affected cords. The needle is used to repeatedly go right through the cords and once these are mechanically weakened, tension is applied on the affected finger while pulling it straight to snap the damaged cords.
This minimally invasive technique once performed will allow the patients to use their hand 24 hours after the procedure with no splints or physical therapy.
2. Needle Aponeurotomy
This is a minimally invasive technique. A small needle is inserted to weaken the affected cords. The needle is used to repeatedly go right through the cords and once these are mechanically weakened, tension is applied on the affected finger while pulling it straight to snap the damaged cords.
This minimally invasive technique once performed will allow the patients to use their hand 24 hours after the procedure with no splints or physical therapy.
3. Collagenase Injection
An enzyme (Clostridial Collagenase) is injected into the cords of the bent fingers to weaken and partially dissolve it. After this procedure has been done, the cords are pulled & mechanically broken to make the damaged finger straight and functional again.
This minimally invasive technique once performed will allow the patients to use their hand 24 hours after the procedure with no splints or physical therapy.
4. Hand Surgery and Treament
Due to the severity and high recurrence rate of the disease, surgical intervention is recommended. There are several types of surgery that can be performed on the hand:
- Limited Fasciectomy – This is the most common surgical procedure performed on patients with Dupuytren’s Contracture. It involves the removal of diseased cords and fascia under regional or general anesthesia. A surgical tourniquet is also applied during the operation to prevent blood flow to the hand.
- Wide Awake Fasciectomy – Local anesthesia with epinephrine is used to perform hand surgery, hence the term “Wide awake”. The operation goes on without the use of a tourniquet.
- Dermofasciectomy – This is a surgical procedure that involves removal of the diseased cords, fascia and the overlying skin and is normally done to patients with high chances of recurrence.
Patients going through surgery usually require a longer time to heal. The operated hand is protected by a dressing and put on a splint for at least 1 week. Afterwards rehabilitation thru physiotherapy is done for a period of 3-6 weeks depending on the extent of the cords & fascia that were excised. On average, the patient’s hand can be functional at least 6 weeks after surgery, with rate of recovery assisted by shockwave therapy.
Extracorporeal Shockwave Therapy (EWST)
Extracorporeal shock wave therapy (ESWT) is a non-invasive tool using high energy focused shockwaves to reduce Dupuytren’s Contracture.
What is the likely duration of the ESWT treatment?
Extracorporeal shock wave therapy Treatment duration varies according to surgeon’s protocols.
