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What is the Least Invasive Dupuytren's Contracture Treatment?

October 18, 2020

Imagine you’re holding up your hand, five fingers splayed apart. Now, tuck your pinkie and your ring finger against your palm, so it looks as though you are asking someone for three items of something.

Now, imagine that you can’t move your pinkie and ring finger at all, but instead they feel stuck to your palm. For many sufferers of a condition called Dupuytren’s Contracture, this is how their condition presents.

What is Dupuytren’s Contracture?

Dupuytren’s Contracture, also known as Dupuytren’s Disease, is a condition usually affecting the hand, although it has been known to affect the feet as well.

It occurs when thefascia - the layer of skin underneath the skin in the fingers and the palm of the hand, begins to thicken over time. This thickening causes a nodule around the ligaments in the hand, resulting in fingers losing flexibility and bending inward, toward the palm.

The disease most commonly affects the pinkie and ring fingers (fingers 4 and 5), and as with many diseases, the extent to which Dupuytren’s affects a sufferer can vary. For some, it means a hard nodule develops in their palm, leaving them unable to place a hand flat on a table, but the disease progresses no further. For others, though, they may be unable to use the last two fingers on their hand at all. 

What Causes Dupuytren’s Contracture?

It’s thought that Dupuytren’s is an inherited disease that originated in Scandinavia, where more cases occur than in any other part of the world. In fact, it is sometimes referred to as the ‘Viking Disease’ and most sufferers are of Nordic descent.

It is more commonly found in men than in women and rarely affects African or Asian people.

As to a definite cause, however, doctors are still not sure, but theMayo Clinic, along with other medical professionals believe that sufferers are more likely to be those who are over 50, male, smokers, heavy drinkers, or diabetics.

Treating Dupuytren’s Contracture 

The disease is easily diagnosed in most cases, as doctors can feel the stiffening of the fascia in the palm or can see the inability of a patient to rest their hand flat on a table.

Dupuytren’s sufferers tend not to feel pain in their hand, but it can be uncomfortable. Most patients report that the feeling of frustration at not being able to use their hand properly is worse than any real discomfort.

There is no cure for Dupuytren’s. The disease received its name from a doctor by the name of Guillaume Dupuytren, who was the first doctor to perform surgery on a patient with the disease in 1831. Now, surgery is a popular and sometimes necessary choice for sufferers.

 

During surgery, the pathological tissue is removed either completely or in part in what’s known as a fasciotomy. However, as with all surgery, there are risks. Patients have suffered nerve damage as a result of fasciotomies, and even with successful surgeries, the risk of recurrence of the disease remains high. For this reason and others, many choose not to have invasive surgery until they are left with no other option, and particularly if blood flow is being severely impeded.

However, before surgery becomes necessary, there are a number of treatments that doctors have recommended in order to slow down the effects of the disease.

Let’s take a look at some of these less-invasive treatments.

Stretching the Fingers

In the early stages of diagnosis, before the disease has become too advanced, the doctor will recommend that the fingers are stretched daily. It’s important to keep the affected fingers moving as much as possible, because even though sufferers may not be able to stop the nodule growing or the fascia becoming tighter, it can help to stop the tissue seizing and stiffening.

For advice on which kinds of stretches are the most effective, a doctor or physical therapist should be a patient’s first port of call. 

Steroid Injections

Local injections of corticosteroids can reduce inflammation and thereby both slow down the progress of the disease and reduce as much pain or discomfort as possible. The injections don’t require a general anesthetic and treatment can be done at your local clinic.

Collagen-weakening Injections

It’s been suggested that injecting certain enzymes into the hand can weaken the collagen that causes the fascia to thicken, so that movement can be eased.

Manual Collagen Division

In other treatments, a very fine needle can be used to manually divide the collagen bands. This treatment has proven to be effective for many people and doesn’t require a general anesthetic, although a local anesthetic is usually applied to the hand before the procedure. 

Radiotherapy

It’s still in its early stages of research, but results of radiotherapy in small studies for treatments of Dupuytren’s have so far appeared successful. It’s not the kind of radiotherapy you might associate with cancer treatment. Instead, low x-ray energy is used to soften the hardening nodules and prevent contractions. 

Magnesium Supplements

Magnesium is known to block the effects calcium has on the body, so it may help to prevent the thickening, or calcifying, of the fascia. Some patients reported improvement with topical magnesium oil, and others with taking magnesium capsules.

Cream

Some sufferers of Dupuytren’s Contracture have found that certain creams applied to their hands have relieved their symptoms. These creams contain ingredients that are known for breaking down scar tissue, and some have noted positive results, and the reduction of nodule swelling.

So, Which Dupuytren's Contracture Treatment is the Least Invasive?

Stretching exercises, and topical creams and oils will always be the least invasive choices, and some patients have reported that they have greatly helped with their symptoms.

However, for patients whose Dupuytren’s contracture is particularly advanced, it’s probable that a doctor would recommend other treatments.

Invasive surgery is usually every doctor’s last resort, and yet it would appear that for long-term benefit, it’s likely the most effective treatment.

In the meantime, doctors are likely to encourage continued use of topical creams or lotions for as long as there is no irritation to the surrounding skin or allergic reaction.


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