Dupuytren’s Contracture

This condition is characterised by a thick ‘cord’ slowly forming in the palm and pulling the fingers down very slowly over several years. It is partly genetic, being more common in northern Europeans. Repeated minor trauma or surgery may also precipitate it. There is no urgency to treat and it is rarely painful. Nuisance symptoms such as difficulty getting gloves on, washing, shaking hands or playing musical instruments are the usual reasons for presentation.
Xiapex is no longer available, so in simple cases we are using Needle fasciotomy (NF). This is done under local anaesthetic in the operating theatre. It is a short procedure and involves inserting a needle under the cord to snap it. It doesn’t remove the cord or the nodules associated with it, but usually improves range easily. Recurrence rates are higher than open surgery, and nerve and tendon injury is a risk (as it is with open surgery).

But recovery is simpler and quicker. Mr Phillips usually refers patients to a Hand Therapist after the procedure for a splint. This will need to be worn until the finger is happily staying as straight as possible. The tendency for it to pull back is variable. While the splint is on you cannot drive. The splint is moulded to fit but can be easily removed and should be removed frequently for skin care and exercise. If there is a skin tear, dressings may be required for a week or so.
Surgery is now reserved for more severe cases. Surgery is however more effective than injections in the long term. I like all my patients to see a Hand Therapist after any intervention, with a view to optimising the outcome. Splints are often required, particularly at night, to prevent early recurrence. Wound care can only begin at 2 weeks when the first postoperative
dressing comes off.

To view a Typical Dupuytrens Contracture Treatment Procedure, please Cick Here