Dupuytren’s contracture: your treatment options explained

Written in association with: Ms Anna Moon
Published:
Edited by: Nicholas Howley

There are many treatment options for Dupuytren’s contracture – but how do they compare to each another? Expert orthopaedic hand surgeon Ms Anna Moon reviews each of the options available to give you the information you need to make an informed choice.

Overview

Dupuytren’s contracture is a connective tissue disorder – the most common in the world, with 6% of the global population affected. It is characterised by the formation of nodules on the palm that can progress to form rope-like collagen cords extending to the fingers.

There are various treatments available for Dupuytren’s contracture. However, it’s important to understand that treatment cannot eradicate Dupuytren's contracture. It can only improve the position of the finger. We can remove, dissolve or divide the nodules or cords which cause the contracture, but we cannot stop them from growing again.

When is treatment recommended?

Treatment is usually indicated when the contracture is bad enough to interfere with daily activities – such as putting gloves on, reaching into your pocket, shaving, or applying cream on the face.

We also make a decision based on what joints are affected. The PIP joints are very unforgiving and stiffen up very quickly, and therefore any treatment is indicated earlier for PIP joint to prevent stiffness, as opposed to the MCP joints.

However, each treatment should be tailored to the individual – considering all the aspects of patients’ daily activities, limitations, and recovery

What treatments are available?

The most effective treatments are:

  • surgical procedures - such as needle fasciotomy or open fasciotomy or limited fasciectomy (where the piece of the cord is divided or removed)
  • collagenase injection (Xiapex) - this is done in an outpatients setting, where the cord is injected on the first day. Within the next few days, the finger is manipulated into extension, when the cord is broken.

Unfortunately, physiotherapy and splinting do not work.

How do treatments compare in terms of recovery?

Recovery is quick following needle fasciotomy or collagenase injection, where it takes about a week for the patient to recover.

Recovery following surgery is longer – stitches are usually removed within two weeks, and the scars settle within six weeks.

Are some treatments more effective in the long-term than others?

Generally speaking, the highest recurrence rates is following the least invasive needle fasciotomy followed by collagenase injection, followed by operation.

However, the recurrence rate varies depending on the type of treatment, age of the patient, and whether the MCP or PIP joint is involved. Recent studies looking at recurrence following Xiapex injection showed that after five years, 47% of MCP joints and 66% of PIP joints showed recurrence of 20 degrees or more.

Although recurrence is common, not every recurrence needs surgical intervention. 10 or 20 degrees of flexion contracture may not interfere with daily activities, and may not need further treatment.

A final point to bear in mind is that recurrence rates appear to slow over time.

By Ms Anna Moon
Orthopaedic surgery

Ms Anna Moon is a highly experienced consultant orthopaedic hand surgeon based in Worcester, Birmingham and Droitwich. She has been a consultant for seventeen years, treating various hand, wrist and elbow conditions such as nerve compression (carpal tunnel syndrome and cubital tunnel syndrome), Dupuytren’s contracture, ganglion cyst, trigger finger, tennis elbow, arthritis (rheumatoid and osteoarthritis), tendonitis and small joint replacement amongst others.

Most of the procedures are done under local anaesthetic using a technique called WALANT (wide awake local anaesthetic no tourniquet) or peripheral nerve block with or without sedation. Ms Moon works with top hand therapists who provide conservative treatment for wide range of conditions and facilitate fast postoperative recovery. She worked as a consultant in the NHS for eleven years, establishing and providing a hand trauma service in the catchment area of Worcestershire and Warwickshire as well providing elective care for patients with hand, wrist and elbow conditions. She is a strong believer in a patient-centred approach, tailoring treatment to each individual case and putting the patient's needs and requirements first.

Ms Moon is highly trained and highly qualified, holding a PhD (her thesis was on microsurgical techniques). She underwent extensive training in hand surgery and microsurgery across Europe. Ms Moon spent nearly two years in Abu Dhabi (United Arab Emirates) working with plastic surgeons on complex hand injuries. She was recently made visiting senior lecturer at Aston University and has been active in presenting and running courses at both a national and international level.

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