Dupuytren's contracture treatment

What is Dupuytren's contracture?

Dupuytren's contracture (or palmar fibromatosis) is a common condition affecting the hand. It begins as small thickened lumps under the skin of your palm. These lumps contain collagen, a type of protein. As the protein builds, a rope-like cord develops and stretches from the palm to a finger. As the cord tightens, it becomes harder to fully stretch your finger and it loses function. The ring and little fingers are most often affected but it's also possible to experience thickening of the skin on your palm and tenderness in the area.

The condition is benign, meaning it is not cancerous. In many cases it develops slowly, resulting in very few symptoms. However, in a small proportion of people with Dupuytren's contracture, one or many fingers can curl into the palms of both hands, restricting movement and making daily tasks difficult.

What causes Dupuytren's contracture?

Genetics play a big role in the development of the disease. Those with close family members who have Dupuytren's contracture are at higher risk than others, with an increased incidence in males and those from Northern Europe and Scandinavia.

Other risks include being middle aged or older, smoking or heavy alcohol use and diabetes.

What treatment options are available for Dupuytren's contracture?

In the early stages, Dupuytren's contracture treatment often involves a watch-and-wait approach, especially if there are no significant symptoms other than a small lump on the palm. If the surgery is performed on these small lumps, they often return quickly.

If the fingers curl towards your palm or start affecting your daily life, there are non-surgical treatment methods available that will be considered before the recommendation of surgery.

Percutaneous needle fasciotomy

Percutaneous needle fasciotomy involves inserting a needle into your palm in several locations. This needle is moved in a sawing-type motion to separate the thickened cord, allowing the surgeon to straighten the affected finger. The procedure is carried out under local anaesthetic, so you'll be awake throughout and, due to the nature of the procedure, you won't need stitches. Often it can be performed in the outpatient clinic, avoiding the need to go to the operating theatre. It is simple, effective and has a fast recovery.

Dupuytren's contracture surgery

In more severe cases of finger contracture, surgery can be carried out to improve worsening symptoms. This can help if you are having difficulty with daily tasks such as dressing or picking up objects. 

Open fasciectomy

In some cases, open fasciectomy is recommended. This is a more invasive surgical procedure performed in an operating theatre. Here, an incision is made into the palm and finger. A surgical blade is used to remove the thickened cord in several places. This allows your finger or fingers to be straightened. 

This type of surgery is usually performed under a general anaesthetic or sometimes an injection that numbs the arm. It is a daycase procedure, meaning you would be expected go home on the day of surgery. Generally, your recovery takes longer than after a needle fasciotomy. The wounds need time to heal and a course of specialist hand therapy is important to guide your recovery.

Rarely, in very severe cases, a skin graft from the forearm is used to cover the skin on the finger. Your surgeon will discuss this if there is a chance this is required.