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  • Q&A with Australian Health Practitioners

    Dupuytren's contracture - what are my treatment options?

    Related Topics
    Hand Conditions Musculoskeletal Health
    What are the treatments for Dupuytren's contracture?
    • 2 answers
    • Brian Lee
    • Mr Harry Clitherow
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    Brian Lee

    Physiotherapist

    I graduated from the University of Melbourne in 2004 and have worked in various healthcare settings, including primary care, private practice and community health services, … View Profile

    As this condition is progressive, so it ultimately leads to an operation, ie tissue release. From experience, physiotherapy isn't going to make any significant long term changes. Assessment from orthopaedic surgeon and subsequent reviews will be ideal to determine when is suitable time for operation. 

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    Mr Harry Clitherow

    Orthopaedic Surgeon

    Mr Harry Clitherow is experienced in the evaluation and management of a wide range of degenerative, traumatic and sports related conditions of shoulder, elbow, wrist … View Profile

    Dupuytren’s contracture is a condition affecting the connective tissue in the palm. Thickened tissue develops and slowly contracts over months to years. This causes the fingers to be gradually pulled into a flexed position. The nerve and blood vessels to the finger can also get caught up in the diseased tissue.

    Patients with significant contracture mainly complain of problems with opening the hand and with gripping objects. The condition is generally not painful.

    There is no cure for the underlying condition, and so treatment is aimed at reducing symptoms. The decision to treat or not is based on how significant the contracture is for the patient. A good rule of thumb is that if you cannot put your hand flat on a table, then treatment may be necessary.

    Unfortunately, therapy and splinting cannot correct the deformity and so the only treatment is to divide or completely remove the offending tissue.

    There are a number of treatment options, each with different benefits and side effects.

    • Needle aponeurotomy involves using a sharp needle inserted through the palmar skin to divide the thickened tissue. It is usually performed under local anaesthetic.
    • A newer treatment is to inject a special enzyme into the cords to weaken them, and then the fingers are manipulated into a straight position a few days later.

    These treatments can be very useful, especially for disease that is mainly in the palm.  

    • The other option is to undergo surgery to completely excise all the offending tissue. This can maximise the amount of correction possible and the nerves and blood vessels to the finger can be safely teased out from the diseased tissue. It is generally the treatment of choice for advanced disease. The main down sides are a scar in the fingers and palm and the risk of wound problems, swelling and pain after surgery.

    If the fingers have been held in a flexed position for a prolonged period then the joints themselves can become tight and they may not be able to fully straighten, even if all the abnormal tissue pulling on them has been removed.

    Because the underlying condition cannot be cured, it is very likely that the abnormal tissue will recur to some extent, regardless of the treatment performed. However, only a small percentage of patients will redevelop a contracture that is bad enough to need further treatment.

    The suitability of each treatment depends on the extent of the abnormal tissue and how severe the contractures are. I recommend that you see a Hand Surgeon to discuss your symptoms and what treatment would be most appropriate for you.

    I hope this helps to answer your question

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