Dupuytren’s Contracture

Dupuytren's contracture is a disorder of the skin and underlying tissue on the palm side of the hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause (though it has a tendency to run in families).

Currently, surgery is the only treatment for Dupuytren's contracture. The surgeon will cut, separate and remove the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done very precisely, since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. In some cases, joint releases and skin grafts are also needed to replace tightened joints and puckered shortened skin.

The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, particularly after physical therapy (see Hand Therapy). A thin, fairly inconspicuous scar is often visible on the hand. Complete straightening of the finger may not be possible, especially if the contracture is severe and long-standing. However, surgery can often give adequate range of motion in the finger, enough to improve its function in daily activities.

Dupuytren’s Contracture can also develop in other fingers or the other hand. Often, if your disease is in both hands, surgery will be undertaken one hand at a time, to allow full function recovery of one hand prior to surgery to the other.

Dupuytren’s Contracture can recur after surgery. The likelihood and the speed at which it recurs depend on several factors, including:

  • the adequacy of excision in the initial surgery'
  • the presence of disease within the skin
  • genetic predisposition
  • stretching exercises to slow contracture of recurrent bands

Treatment for recurrent Dupuytren’s contracture is repeat surgery to remove the recurrent band. Skin often has to be excised if involved in recurrent disease and skin grafting may be required.

Collagenous injection for treatment of Dupuytren’s contracture is still currently under study. Entry to the international multi-centre trial has closed, thus the treatment is not currently available in Australia. The efficacy and safety of this treatment are being assessed and analysed. If evidence shows that the treatment is effective with an acceptable risk profile, it will still have to undergo TGA approval prior to being available to the general public.

(Some information is courtesy of the American Society for Surgery of the Hand)

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