Dupuytren’s contracture: A guide to surgical and non-surgical treatment

While surgery may be considered in extreme cases, the majority of patients suffering from Dupuytren’s contracture are able to resolve their symptoms with conservative (non-surgical) treatments. We invited revered consultant orthopaedic surgeon Mr Stephen Lipscombe, who specialises in hand and wrist surgery, to share his expert insight on the available treatment options and the most likely outcomes for patients living with this condition.

What is Dupuytren's contracture?

The skin on the palm is anchored to the underlying soft tissue by normal fibrous bands. In Dupuytren’s disease, these thicken to form lumps in the palm and fingers. Tight bands then sometimes develop which cause the fingers to curl. Patients typically report the curled finger catches the face when washing, and that they also have difficulties with using a keyboard and donning gloves, as well as clumsiness in the hand.

How is Dupuytren's contracture diagnosed?

The diagnosis is based upon clinical examination. Rarely, pathology examination of the removed lump is required.

What are the non-surgical treatment options for Dupuytren's contracture? How effective are they?

Some patients adapt well to using the hand and report few difficulties. The use of splints and physiotherapy unfortunately do not seem to halt disease progression. Steroid injections into tender nodules provide temporary relief.

Cycles of radiotherapy are used at some centres to try and halt disease progression although few patients are suitable for this technique. Immune modifying drugs to treat Dupuytren’s disease are only in clinical trials at present.

When is surgery recommended for Dupuytren's contracture?

There are a number of surgical techniques available dependent upon the nature of the cord, overlying skin, and degree of contracture. Unfortunately, none are curative and disease recurrence is always a possibility.

• Percutaneous needle fasciotomy, when the tight band is released using a needle, is quick and can be very effective although disease recurrence is higher than other techniques.
• Limited surgical fasciectomy involves angled cuts into the hand and fingers to remove the diseased tissue. Recovery is slower but recurrence is less likely than with needle fasciotomy.
• Dermofasciectomy involves angled cuts removing the overlying skin and diseased tissue. Skin grafting typically taken from the arm or groin is required to cover the defect. Recovery is slower again with added potential complications but recurrence is least likely with this procedure.

In rare cases, for recurrent disabling disease, amputation of the affected finger is performed.

What are the long-term outcomes of untreated Dupuytren's contracture?

The disease is unpredictable and for many patients, some lumps or minor bands with little impact upon daily life is all that is experienced. For some, however, disease progression may be more aggressive with multiple fingers affected requiring repeated procedures.

If you would like to schedule a consultation with Mr Lipscombe, you can do so by visiting his Top Doctors profile.