Dupuytren’s contracture

Dupuytren’s contracture is a benign condition whose origin is unknown. It affects a membrane situated between the skin and the flexor tendons in the palm of the hand (aponeurosis).

This disease causes the aponeuroses to become denser and thicker. Nodules form causing one or more fingers to bend into the palm of the hand. The disease’s progression prevents the full extension of the joints although it doesn’t prevent the flexion of the fingers.

The origin of this condition can be genetic. Therefore, other members of the family may have it.

Dupuytren’s contracture: symptoms and diagnosis

One or more nodules can be felt in the palm or finger. These nodules cause the skin to retract and prevent the full extension of the finger.

A clinical examination is used to diagnose the disease.

Dupuytren’s contracture: treatment and progression.

There is currently no cure for this disease. The only possible intervention consists of removing the diseased tissue. Surgical techniques can’t prevent the spread of the disease to other fingers or prevent it from recurring in the operated fingers.
Medical treatment

Different types of treatment are available to help recover the normal extension of the fingers. Each case is treated on an individual basis and discussed with the patient in order to find the most appropriate treatment.

In general, immobilisation orthosis is required for several weeks.

Injections of collagenase may also be recommended. This simple treatment has the advantage of a very low morbidity and a rapid return to normal activity. This type of treatment is only applicable to “cords” (nodules that extend over time) that can easily be felt. This intervention is reimbursed following strict guidelines by the Belgian Health Legislation (RIZIV-INAMI) up to 3 injectable doses per hand per year (with a lifetime maximum of 8 doses per hand).

Surgery is only suggested if deficient extension causes impairment. However, while it affects proximal interphalangeal joints, it may lead to secondary joint stiffness which is very difficult to treat. Subsequently, surgery is recommended as soon as there is an extension deficiency of 30 degrees or more in these joints.

Later surgery doesn’t lead to joint stiffness in the metacarpophalangeal joints.

Several surgical options are available and will be considered on a case by case basis.

The first one is simple: it is just a matter of cutting the cord with a needle. Within the context of Dupuytren’s contracture, this operation is performed under local anaesthetic. It can only be performed if the cord is easy to feel subcutaneously. Therefore, it isn’t always possible to achieve full extension if some of the cords are inaccessible.

The second technique requires the surgical removal of the cords through classic cutaneous incisions. This technique is performed under local anaesthetic. Ultimately, it will enable the full extension of the fingers in the majority of cases. This technique is more complicated than the first one.

The third method involves the surgical removal of the cords and the skin, followed by a skin graft. This technique requires a meticulous and in-depth dissection. It helps to solve both the problems of deficient extension and skin problems. The recurrence rate is lower.

This option is used when there is a recurrence following surgery or in young patients where the disease is particularly aggressive and the recurrence rate is very high in the short term.