Dupuytren's Contracture Diagnosis and Treatment

What is Dupuytren’s Disease?

Dupuytren’s Contracture is also known as Viking hand. Everyone has gristle in the hand, this is the same white, shiny gristle we see on meat at the grocery store. It is shown here in this diagram.
In many people, the gristle hardens and thickens with age. The gristle is in the palm as shown here and extends up into the fingers as well.

How does Dupuytren’s Contracture Progress?

Some people may notice bumps or nodules in the palm, as seen here. Others may notice a line or cord or thickened gristle, as seen here.
As the condition progresses, some patients can develop a permanent bend in the finger, known as a contracture as seen here.

Can Dupuytren’s be Cured?

Dupuytren’s cannot be cured.
The symptoms can be treated. If someone is unable to lay the hand flat on a table due to the contracture or bend, this can be treated.

How is Dupuytren’s Contracture Treated?

Early on, the nodule can be massaged. Massaging the nodules with something like a golf ball or a similar device may help.
Once the cord develops, one can stretch the finger to try and increase the motion and decrease the amount of restriction.
Regardless of what type of treatment you have, Dr. Anzarut suggests five minutes of firm finger stretching with each meal or 15 minutes a day.

Can Surgery Treat Dupuytren’s Disease?

Historically, Dupuytren’s disease was treated with surgery. Surgery is rarely used in my practice due to certain side-effects. These include:

Cold intolerance.
Changes in sensation.
Unpredictable results in the finger joint or PIP region.
Necessary postoperative splinting and therapy.
A long recovery of four to six weeks.
Scarring of the skin which inhibits future treatment or impairs future treatment. That is probably the most important reason why I no longer provide surgery as a first option.

There are also risks with surgery:

There’s a higher risk of infection.
A higher risk of nerve injury.
A higher risk of immediate recurrence of a contracture due to scarring than with other treatments.

This photograph shows a patient who has undergone surgery for removal of the thickened gristle. The thickened gristle is shown here. It has been taken out of the finger.

What is the First Choice for Treatment of Dupuytren’s Contracture?

Needle release or aponeurotomy is my treatment of choice.

A needle is placed through the skin to cut the tight cord.
It is like cutting a link in a chain fence or in a chain. It loses its pull.
This is done in the office or clinic.
It is done with local anesthetic or freezing.
There is no need for postoperative therapy or splinting.
The results are immediate, and the recovery is almost immediate.

Dr. Anzarut has performed over 2000 needle-releases. These are my recommendations:

What to do before surgery:

Start your antibiotics the morning of the procedure.
Use a chlorhexidine sponge to wash the hand the night prior and morning of the procedure.

What to do after surgery:

Keep the hand clean for four weeks. This means no gloves, no gardening, and no submersion under water and no lawn bowling. Showers and running water are fine. Dr. Anzarut has had two infections; both patients went lawn bowling immediately afterwards.
Do not hold hot objects while your hand is still numb from the anesthetic. This may lead to a burn. Two patients have had burns by holding hot objects while the hand was still numbed.
Do not grip or lift more than five pounds for two weeks after the procedure. There is a very small risk of tendon rupture if the tendons are stressed during the first two weeks after the procedure.
Nerve injuries are possible; however, permanent nerve damage is rare. The only patients who have suffered long-term changes in sensation are those that have had surgery on the same digit in the past. Dr. Anzarut no longer performs needle release if surgery was done on that digit.
Stretch the finger for five minutes with each meal FOREVER to avoid an early recurrence.

Limits of the Needle Release Procedure

When the finger joint or PIP is held in flexion for an extended period of time, the joint can develop chips, damage to the cartilage and arthritis. This diagram shows the PIP joint here. For some patients, this prevents full straightening even after the gristle has been treated.
Some patients develop weakness of the straightening muscles of the hand. They may require a period of splinting after treatment.
Finally, the lumps or nodules are not well-treated with the needle release.
Recurrence of the bend or contracture does tend to occur over time. Stretching is important to delay this. The needle release can be repeated when a recurrence occurs.
It does not work in a digit that has had surgery, however. This is one reason Dr. Anzarut avoids surgery for Dupuytren’s.
Some patients may develop an open skin wound with the needle release. If this occurs, it requires two to four weeks to heal. This occurs in approximately two to five-percent of patients.

What is the Second-Line Treatment for Dupuytren’s Disease?

Anzarut injects a medicine sometimes to treat the hand with Dupuytren’s. Dr. Anzarut uses this injection of medicine in fingers that have already had surgery.
This medicine is also known as a collagenase and it helps to dissolve some of the gristle.
It has some disadvantages, however.

It can dissolve other structures in the hand.
It may lead to unexpected side-effects and pain and swelling of lymph nodes.
The drug cost is significant. It costs over $1500. If you have extended drug coverage, you may only need to pay $100-400.

Who is a Candidate for a Needle Release?

Patients who meet the following criteria are candidates for a needle release.

They are unable to place their hand flat on a table due to a fixed bend or contracture. These people may be candidates.
Individuals who have not had surgery on the involved finger.

If you meet these two criteria, you are likely a candidate for surgery. If you would like to see Dr. Anzarut for a needle-release surgery, please have your family doctor provide a referral to Dr. Anzarut’s office.

Dupuytren’s Contracture Diagnosis and Treatment