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What Is the Best Way to Treat Dupuytren's Contracture?

January 16, 2021

What is Dupuytren's contracture?

Dupuytren's Contracture is a hand deformity that is caused by an unusual thickness in a layer of tissue underneath the skin of your palm or the base of your fingers. Over years the thickened area turns into a hard lump or a cord that pulls one or more fingers towards the palm or sideways.

The middle and ring fingers are most often affected, and in most cases it affects both hands. It is more common in older men of Northern European descent. It makes everyday tasks quite difficult since the affected fingers cannot be straightened completely.

Causes

The exact causes of Dupuytren's Contracture are unknown, although it is hereditary. However, certain factors and lifestyle choices make the chance of getting the disease more likely. These risk factors are:

  • Alcoholism
  • Taking medicines to treat epilepsy
  • Smoking
  • Diabetes
  • Family history
  • Men older than 40 years
  • People of North European descent

Diagnoses

Diagnosing Dupuytren's Contracture is easy as it does not require many tests. Your doctor will simply examine your hands and come to a conclusion. The doctor will check your grip and flexibility of your fingers and press the knots and bands on your palm. They might ask you to lay your hands flat on a table, naturally, an ability to do so will mean you have the disease.

Treatment

Currently, there is no medication or treatment available that can be used to stop Dupuytren's Contracture from progressing or cure it completely. The treatments available and their usage mainly depend on how severe the disease is. If the disease has progressed to a level that it is causing a disability then various treatment options can be considered.

Initially, after you have been diagnosed with Dupuytren's Contracture, the doctor will wait and see to determine how your disease is progressing. If it progresses to a level that makes daily tasks difficult, then your doctor will let you know the best treatment options for you and the pros and cons of each.

The treatments for Dupuytren's Contracture can be broadly divided into surgical and non-surgical.

Surgical Treatments

Surgery

Open surgery is for people with advanced Dupuytren's Contracture, that has progressed to a point where there is limited functionality in the hand. The surgeon will make an incision in your palm and remove the affected tissue (fasciectomy). Open surgery offers a more comprehensive and long-lasting treatment. On the other hand, it is invasive and requires physical therapy and a long recovery period after the surgery.

This surgery itself is safe, however in cases that are severe and those that cannot be corrected by normal surgery, the surgeon might take out all tissue (including the skin). In such cases the surgeon will perform a skin graft by taking a piece of skin from another body part. After the surgery, the patient might require months of physical therapy and a very long recovery time.

There can be significant scarring of the hand, especially if the surgeon makes a “zig-zag” incision along the creases in the hand.

One thing to remember however is that surgery is still not a cure and the healing tissues can potentially form similar cords in the future. Despite this, surgery can meaningfully restore the hand’s functionality for most patients, although it is very likely to come back.

Revision surgeries can actually be trickier than the initial surgery performed to treat Dupuytren's Contracture. The formation of scar tissue on the affected area can make repeat surgeries more prone to complications.

Needle Aponeurotomy

Needle Aponeurotomy is a relatively new and minimally invasive procedure to treat Dupuytren's Contracture. It is an alternative to surgery and performed by specially trained doctors.

To conduct the procedure, the doctor will first apply local anesthetic to your hand. She will then use a hypodermic needle and pass it back and forth through the cords to weaken or rupture them. By doing so, the doctor hopes that the cord would elongate and allow normal hand functionality.

The advantages of this procedure are that it is not very invasive, can be performed on several fingers, and requires less recovery time. However, it needs to be carefully done to prevent nerve damage. Like surgery, the disease can recur in which case more procedures can be done.

Non-Surgical Treatments

Now we will highlight non-surgical and minimally invasive treatments for Dupuytren's Contracture.

Enzyme injections

Enzyme Injections are a new type of treatment for Dupuytren's Contracture that has been recently approved by the FDA. The enzyme approved is Xiaflex, a collagenase Clostridium histolyticum. It is injected directly into the cords by specially trained doctors, in order to weaken or loosen it.

It takes the enzyme around 24 to 72 hours to effectively break and weaken the cords. After this the doctor will give you a local anesthesia and try to straighten your bent fingers to pull apart the cords. This can bring back the motion in your fingers and straighten them.

Early results for this procedure are promising(click here), although more time and detailed studies are required to figure out its long-term effects. Potential complications for enzyme injections can be similar to those of surgery. Generally, enzyme injections result in lesser pain and swelling than surgery but in extreme cases, the patient can have an allergic reaction.

Stretching

Stretching is the easiest of all treatments and can be used initially for the mildest form of Dupuytren's Contracture. It can also be used in conjunctions with other treatments or procedures.

Steroids Injection

Injecting steroids into Dupuytren's nodule is another treatment that can be used in the initial stages of the disease. Corticosteroids are strong anti-inflammatory drugs and can potentially slow down the progression of the contracture and reduce the size of the nodules. However, if the contracture is already present then steroids will not be effective.

Multiple injections are often required and the effectiveness of this treatment varies among patients.

Radiation Therapy

There aren’t many studies to support the use of radiation therapy for treating Dupuytren's Contracture but it’s still used as a treatment option for the disease. Low-energy radiation therapy may reduce symptoms and prevent further tightening of cords and the skin changes that are associated with the disease.

Splinting

Splinting can actually be harmful to your finger if it’s used as a preventive measure for Dupuytren's Contracture. Instead of stopping progression, splinting a bent finger can injure it. Splinting might be used after a surgery for Dupuytren's Contracture to protect the surgical area.

Salvage Procedures

Salvage procedures are a last resort for people with Dupuytren's Contracture. Sometimes the treatments for this disease do not work as well expected or are unable to prevent further disease progression. For very advanced cases, fingers might contract to a point where they are just not fixable.

The point of a salvage procedure is to make an intolerable situation tolerable, it is NOT meant to fix the issue. A few salvage procedures used to help Dupuytren's Contracture patients are:

  • Joint fusion: For patients who have completely bent fingers that cannot be treated otherwise, joint fusion can performed to set the joint permanently in place. Essentially, a surgery is performed to fuse the joint in place so that it will never bend again even if Dupuytren's worsens.
  • External fixation: For people with much contracted tissues, an external fixator can be used to stretch the soft tissues around the joints and fingers. External fixators are attached to the bones with the help of screws or pins, and prolonged use may help people with Dupuytren's.
  • Amputation: According toDegreef I, De smet L, Dupuytren's Contracture is a primary reason for elective finger amputation among adults. Although, it is rarely performed and only used in the most extreme cases, finger amputation can help increase hand functionality in some cases. 

Dupuytren's Contracture All Natural Cream

Dupuytren's Contracture All Natural Cream is currently the only all natural external cream that can be used for Dupuytren's Contracture. The cream is manufactured and sold by DupuytrensCo, the link to their website is (click here). The cream can be used to treat the symptoms and pain associated with the disease and many users have found it helpful.

Dupuytren’s Cream uses a combination of natural anti-inflammatories and anti-scarring agents in an effort to fight symptoms and prevent the disease from progressing. The cream mainly contains Sunflower Oil, Vitamin E, Tamasul Oil, Aloe Vera, and Arnica-Montana. Users are advised to use the cream twice or thrice a day for 30 to 45 days to see results.

The obvious advantage of Dupuytren’s Cream is that it is non-invasive with no known side-effects.

So What Is the Best Way to Treat Dupuytren's Contracture?

We have listed some of the top treatments used for Dupuytren's Contracture. However, the best treatment really depends on your condition and your doctor’s recommendation. While some treatments are appropriate for the initial stages of the disease others are used during the advanced stages.

Before opting for any treatment, make sure you weigh all the pros and cons and have an in depth discussion with your doctor.


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