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Dupuytren’s Contracture

dupuytren before aponeurotomy supinatedDupuytren’s contracture is a thickening of the fibrous layer (the Cord) under the skin of the palm and fingers. It is painless, but can be slowly progressive. The patient usually notices the thickening for a while before he seeks attention. With time, the fingers start to curl and it becomes difficult to straighten the fingers such as to shake hands or reach into a pocket. The patient may also notice thick nodules in his palm, as well as ‘pits’. It often affects the fifth and fourth digits, but can affect any and all of them. It can affect both hands at the same time as well as the feet.

dupuytren before aponeurotomy pronated

We do not know what causes the contracture, but we know that it runs in families, especially those with Northern European or Scandinavian  ancestry.

There is no cure for the contracture. Splinting usually does not help. Surgical intervention is usually deferred until motion is affected. There are  options for intervention summaries as follows

  1. dupuytren animationEnzymatic Digestions: During the last few years, enzyme injection has become popular. It is performed by injecting an enzyme into the cord after numbing it. Then after a day or two, the cord may pop spontaneously, or sometimes, a manipulation is performed by the physician.
  2. Needle Aponeurotomy: This is my favorite.  After numbing the area with a local anesthetic injection, I use a hypodermic needle to divide the diseased tissue. No incision is required and this procedure in done in my office and the patient gets to watch and take part.
  3. Open Surgical Resection: This requires a trip to the operating room. A formal incision is made and the cord is excised. A splint is worn for two weeks.

dupuytren after aponeurotomy pronated

All the above options carry a risk of recurrence, and each has a slightly different but mostly equivalent risk profile. The patient will have to weigh his options and decide for himself which option suits him best.

For more information, check out the Dupuytren Foundation website.

 

 

1-minute Demonstration of Needle Fasciotomy


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