Dupuytren's Contracture Treatment Guidelines

What is Dupuytren's contracture?

Dupuytren's contracture is a hand deformity that develops gradually, affecting a layer of tissue beneath the skin of the palm. This condition pulls the fingers into a bent position, rendering them unable to fully straighten. It is characterized by thickened and diseased tissue forming knots under the skin that create a tight cord, pulling one or more fingers into this contracture.

Risk factors for Dupuytren's contracture include family history, and is more prevalent in people of Northern European descent.  The exact cause is unknown, but it is believed to involve genetic predisposition.

Symptoms typically start with lumps or nodules in the palm, which can be tender initially. As the condition progresses, the skin on the palm may appear puckered or dimpled. In advanced stages, physical therapy and physical medicine interventions may help, and in severe cases, a skin graft might be necessary to correct the deformity. (Kovacs et al., 2023)

How to manage and treat Dupuytren's contracture

Managing Dupuytren's contracture involves various methods, depending on the severity and progression of the disease. Below, we outline both non-surgical and surgical treatments.

Observation

In cases where Dupuytren's contracture is mild and does not limit function, observation may be appropriate. Monitoring the disease's progression and the condition of the affected fingers allows for timely intervention if the contracture worsens.

Splinting

Splinting is not recognized as an effective method to halt the progression of a finger contracture. Additionally, forcefully stretching a contracted finger provides no benefit and may actually cause injury to the finger or hand.

After surgery for Dupuytren's contracture, splinting can be used to protect the surgical site. However, it remains uncertain whether wearing a splint reduces the risk of recurrent contracture or prevents the tightening of the healing wound.

Needle aponeurotomy

Needle aponeurotomy is often performed in an office setting under local anesthesia. During the procedure, a small needle is inserted through the skin into the affected finger(s) to disrupt or sever the abnormal tissue. This technique helps improve the range of motion and alleviates the pain and discomfort associated with Dupuytren's contracture.

Collagenase injection

Collagenase injections offer a minimally invasive treatment for Dupuytren's contracture. This enzyme dissolves the thickened tissue, allowing one or more fingers to straighten. This treatment is effective for one or more fingers and has a quicker recovery time than surgery (Kovacs et al., 2023).

Surgical therapy

Surgery is considered when contractures significantly impair hand function. Techniques include:

• Fasciectomy: Removing the diseased tissue to straighten the affected fingers.
• Skin graft: In severe cases, a skin graft may be necessary to cover the wound after the diseased tissue is removed.
• Dermofasciectomy: Removing both the diseased fascia and overlying skin, often followed by a skin graft.

Corticosteroid injection

Corticosteroid injections can reduce inflammation and nodule size in the early stages of Dupuytren's Contracture. These injections help manage symptoms and slow disease progression.

What is a Dupuytren's Contracture Treatment Handout?

The Dupuytren's Contracture Treatment Handout is a resource tailored for healthcare professionals managing this condition. It covers various suitable treatment options for affected fingers and disease progression. These options include nonsurgical approaches such as physical therapy to maintain finger function and collagenase injections to dissolve diseased tissue, sometimes followed by a skin graft. It also references surgical interventions like fasciotomy or fasciectomy are detailed, along with postoperative care instructions.

Benefits of using this handout

Using our Dupuytren's Contracture Treatment Guidelines Handout provides numerous benefits for healthcare professionals managing this condition:

• Comprehensive guidance: Offers a detailed roadmap from diagnosis to treatment, covering nonsurgical options like steroid injections and percutaneous needle fasciotomy.
• Clear treatment pathways: Helps navigate surgical interventions such as fasciectomy and skin grafting, ensuring optimal outcomes for affected hands and fingers.
• Educational resource: Equips healthcare providers with insights into managing thick cords and preventing recurrence, promoting patient education and adherence to treatment plans.
• Evidence-based approach: Supports informed decision-making with current best practices and guidelines, reducing the risk of complications and enhancing treatment efficacy.
• Improved patient care: Enhances continuity of care by standardizing protocols, addressing commonly affected areas like the little fingers, and minimizing the need for other treatments.

References:

Kovacs, E., Battafarano, D., & Mathew, S. D. (2023). Dupuytren contracture treatment & management: Approach considerations, rehabilitation, collagenase injection. EMedicine. https://emedicine.medscape.com/article/329414-treatment?form=fpf