Dupuytren’s Release

If the disease progresses slowly, causes no pain, and has little impact on your ability to use your hands for everyday tasks, you might not need treatment. Instead, you can wait and see if Dupuytren’s contracture progresses. You may wish to follow the progression with a tabletop test, which you can do on your own.

Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways. The choice of procedure depends on the severity of your symptoms and other health problems you may have.

• Needling – This technique uses a needle, inserted through your skin, to puncture and break the cord of tissue that’s contracting a finger. Contractures often recur but the procedure can be repeated. The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually, very little physical therapy is needed afterward. The main disadvantage is that it can’t be used in some places in the finger because it could damage a nerve or tendon.
• Enzyme injections – Injecting a type of enzyme into the taut cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. The FDA has approved the collagenase Clostridium histolyticum (Xiaflex) for this purpose. The advantages and disadvantages of the enzyme injection are similar to needling. Enzyme injections are not offered at all medical institutions.
• Surgery – Another option for people with advanced disease, limited function, and progressing disease is to surgically remove the tissue in your palm affected by the disease. The main advantage of surgery is that it results in a more complete and longer-lasting release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and recovery can take longer.

In some severe cases, especially if surgery has failed to correct the problem, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases, a skin graft is needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward.