Dupuytren’s contracture: your treatment options explained

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.