What Is the Best Way to Treat Dupuytren's Contracture?
What is Dupuytren's contracture?
Dupuytren's Contracture is a hand deformity caused by an unusual thickness in tissue of the palm or the base of the fingers. Over years, the thickened area turns into a hard lump or cord that pulls one or more fingers inward or sideways.
The middle and ring fingers are most often affected, and this deformity usually happens in both hands. It is more common in older men of Northern European descent. Dupuytren's often makes everyday tasks quite difficult since the affected fingers usually cannot be straightened completely.
Currently, there is no medication or treatment that can be used to completely eliminate Dupuytren's Contracture. The treatments that are available are recommended based on how severe the disease is.
Initially, after someone has been diagnosed with Dupuytren's Contracture, the doctor will wait a period of time to determine how the disease is progressing. If it advances to a level that makes daily task completion difficult, then your doctor will let you know the best treatments and any disadvantages, if they exist. The treatments for Dupuytren's Contracture can be broadly divided into two categories: surgical and non-surgical.
Open surgery is for people with advanced Dupuytren's Contracture that has severely limited the functionality of the hand. Your surgeon will make an incision in the palm and remove the affected tissue. This procedure is called a fasciectomy. Open surgery offers more long-lasting effects, but it is invasive and requires someone to attend physical therapy in order to fully recover.
This surgery itself is safe, but severe symptoms may require your surgeon to remove all tissue and from the palm. If this is necessary, they will then perform a skin graft by covering the area with a healthy piece of skin from another part of the body. This surgery also requires someone to receive physical therapy for months afterwards. Both of these surgeries may lead someone to experience scarring, especially if the surgeon makes an incision in the shape of a zig-zag along the creases of the hand.
One thing to remember is that surgery will not cure this condition and tissues can still develop cords and hardness in the future. Despite this, surgery can restore a person's ability to use their hands functionally for some time. Revision surgeries (those done after an initial surgery) can actually be trickier than standard surgeries for Dupuytren's Contracture because the formation of scar tissue can cause more complications.
A needle aponeurotomy is a relatively new and minimally-invasive procedure that treats Dupuytren's Contracture. Specially-trained doctors perform this surgical alternative by applying local anesthetic to your hand. They then pass a hypodermic needle back and forth through the cords to weaken (and simultaneously lengthen) them. This restores functionality and eliminates some tightness that usually causes issues.
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 does need to be carefully done to avoid damage to nearby nerves. Like surgery, the disease can recur, so more procedures can be done to help fix this.
Stretching is the easiest of all treatments and can be used for the mildest forms of Dupuytren's Contracture, since this is usually when it's most effective. It's a good fit for many people because it has no side effects and can be used alongside other treatments or procedures.
Injecting steroids into Dupuytren's nodule is another treatment that can help during the initial stages of the disease. Corticosteroids are strong anti-inflammatory drugs that can potentially slow down the progression of the contracture and reduce the size of nodules. However, steroids are not effective if a contracture is already present. For mild cases, multiple injections are often required. This procedure is evidence-based, but its effectiveness varies among patients depending on their circumstances.
There aren’t many studies that support the use of radiation therapy for treating Dupuytren's, but it's still a viable option. Low-energy radiation therapy may reduce symptoms, prevent further tightening of cords, and deter skin changes.
Preventive splinting can actually be harmful to the finger if it’s used to stop it from bending inward. Splinting for Dupuytren's is indicated after surgery, since it protects the area and allows the incision to properly heal.
Salvage procedures are a last resort for people with Dupuytren's Contracture. Sometimes treatments for this disease do not work as expected. For very advanced cases, the fingers might contract to a point where they are not usable or able to be fixed.
The point of salvage procedures is to make an intolerable situation slightly better, but they are 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 are nearly immovable, fusion can set the small joints of the finger permanently in a straightened position. This surgery locks the joint so that they never bend again, even if Dupuytren's worsens.
- External fixation: For people with significantly contracted tissues, an external fixator can be used to stretch the soft tissues around the joints. External fixators are attached to the bones with the help of screws or pins. Prolonged use of these devices may help people with Dupuytren's.
- Amputation: Research shows that Dupuytren's Contracture is a primary reason for elective finger amputation among adults. Although it is only used in the most extreme cases, finger amputation can help increase hand functionality for some people.
Dupuytren's Contracture All Natural Cream
All natural cream is currently the only lotion that can be used for Dupuytren's Contracture. This cream can be used to treat the stiffness and pain associated with the disease. Many users have found it helpful for these reasons.
Dupuytren’s Cream uses a combination of natural anti-inflammatories and anti-scarring agents to fight symptoms and prevent the disease from progressing. The cream consists of active ingredients such as sunflower oil, Vitamin E, tamasul oil, aloe vera, and arnica montana. It's recommended to use this cream two or three times daily for 1-2 months to see results. The obvious advantage of Dupuytren’s Cream is that it is non-invasive and has 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 more appropriate 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.