All rights reserved © Munawar Shah, 2009

Treatment for Dupuytren's contracture (Dupuytren's disease) is usually only required if the condition affects the function of your hand. Many cases are mild and don't need to be treated.

The treatment used largely depends on the severity of the condition. In milder cases that require treatment, non-surgical treatments or a minor procedure called a needle fasciotomy may be recommended.

For more severe cases, surgery is an effective and widely used treatment. The two most common surgical procedures are an open fasciotomy and a fasciectomy.

Non-surgical treatments

Non-surgical treatment options for Dupuytren's contracture may include radiation therapy and a medicine called collagenase clostridium histolyticum. These are generally most effective if used before the condition becomes severe.

Radiation therapy

In 2010, the National Institute for Health and Care Excellence (NICE) issued guidance about the use of radiation therapy to treat Dupuytren’s contracture. Radiation therapy aims to prevent or delay the need for surgery.

Radiation therapy may not be suitable for everyone with Dupuytren's contracture. If you're offered radiation therapy, you should be aware of the uncertainty about its effectiveness and the possible – although very small – long-term risk that radiation may cause cancerous tumours.

I do not offer radiation therapy.

Collagenase clostridium histolyticum

Collagenase clostridium histolyticum is a medicine that can be injected into cords in the palm of your hand. The medicine contains special proteins that can weaken the cords.

After having the injection, you'll be monitored for around half an hour and then you can go home. You return to your doctor 24 hours later and they'll straighten your bent finger and stretch it out for 10 to 20 seconds. This breaks the cord and should help to increase the range of movement in your bent finger.

 

 

 

 

If the first injection isn't effective, you can have up to three injections in the same cord, with one month between each injection.

Needle fasciotomy

A needle fasciotomy is also known as a needle aponeurotomy or a percutaneous needle fasciotomy (percutaneous means "performed through the skin").

It's usually performed as an outpatient procedure, meaning you won't need to be admitted to hospital. You'll be given a local anaesthetic to numb your hand without making you lose consciousness.

During the procedure, a sharp blade or a very fine needle will be inserted into the fibrous bands in the palm of your hand or your fingers. The blade or needle will be used to divide the cord under your skin.

By dividing the thickened tissue, your surgeon will release the tightness in your hand that's forcing your finger to bend.

The benefits of needle fasciotomy include:

your fingers are less deformed

you recover more quickly compared to more extensive surgery

it's suitable for people who are unable to have more extensive surgery, such as the very frail or elderly

it has a low risk of complications (around 1%)

However, the rate of recurrence for Dupuytren’s contracture is very high: as many as 60% of people who have a needle fasciotomy experience Dupuytren’s contracture again within three to five years.

 

 

 

 

 

 

 

 

Open fasciotomy

An open fasciotomy is sometimes used to treat more severe cases of Dupuytren's contracture. The procedure is more effective in the long term than a needle fasciotomy, but it's also a more extensive operation and carries some additional risks

Fasciectomy

A fasciectomy involves removing the thickened connective tissue. There are three variations of the procedure:

regional fasciectomy – where the affected connective tissue is removed through a single, larger incision; this is the most commonly used type of surgery for Dupuytren’s contracture

segmental fasciectomy – where one or more small cuts are made in the skin, through which small segments of connective tissue are removed

dermofasciectomy – where the affected connective tissue is removed, along with the overlying skin (which may also be affected by the disease) and the wound is sealed with a skin graft (where healthy skin is removed from another part of the body and used to cover the area of skin loss in your hand)

 

 

 

 

 

 

 

 

 

 

A new enzyme called Collagenase Clostridium Histolyticum has recently been approved for use in the UK by the European Medicines Agency. The enzyme is marketed in the UK under the brand name of Xiapex.

Collagenase Clostridium Histolyticum can be injected into the cord that has formed in the palm of your hand. The medicine contains special proteins that can break up the collagen fibres in the cord. This weakens the cord, eventually allowing the bent finger(s) to be straightened.

The injection is done as an outpatient. The doctor will usually mark the site for the injections so that the enzyme is injected into the cords, avoiding tendons, nerves and other important structures. The injection has been described as feeling like a bee sting. You return to the doctor 24 hours or more after the injection, when under a local anaesthetic, the bent finger(s) are physically straightened and held stretched out for 10 to 20 seconds. This breaks and disrupts the cord and should increase the range of movement in your bent finger.

If the first injection is not effective, you can have up to three injections in the same cord, with one month between injections.

In one study looking into Collagenase Clostridium Histolyticum, nearly two thirds of people could almost completely straighten their finger after the injections.

The patient leaflet for Xiapex lists considerations when caution must be taken for using this treatment:

  • known allergy to the ingredients. There is a risk of anaphylactic shock that the surgeon must be prepared for.

  • problems with blood clotting

  • taking anti-coagulants

  • pregnant

  • under age 18

The most common side effects occur around the site of the injection. These include:

  • swelling

  • bruising

  • bleeding

  • pain

  • inflammation

These should improve within a week or two. Less common side effects include feeling sick or dizzy, lumps in the glands under your arm, and there have been reports of new Dupuytren's nodules flaring up.

Collagenase Clostridium Histolyticum is still a very new treatment. There are examples of results from short-term studies, but the long-term effects are unknown.