What are Dupuytren’s disease treatments?
Dupuytren’s disease is a progressive thickening and tightening of the fascia over the palm of one or both hands. This can result in flexion (curling up) of fingers, especially the ring finger and little finger.
Dupuytren’s disease may be treated with:
- watchful waiting
- medications (eg collagenase injections)
Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.
How do Dupuytren’s disease treatments work?
Many patients enquire about non-surgical treatment(del). While options such as night splints may provide some relief, they have not been shown to significantly alter the course of the disease.(New paragraph)
Collagenase injections have been shown to work well for many people and offer the benefit of avoiding surgery and the time taken for surgical scars to heal.
What are collagenase injections?
Collagenase injections describe a procedure where a medicine called collagenase Clostridium histolyticiumis injected into the thickened fascia. Collagenase contains enzymes (special proteins) that can breakdown the thickened tissues.
Collagenase injections have been shown to correct affected joints, with most of theeffect of each injection being immediately obvious following manipulation.
Collagenase injections are relatively new to Australia and we don’t have many long-term studies on its usefulness. This option will be discussed at your consultation, but please be aware only some patients will be suitable for this treatment.
What is involved?
The injection of collagenase is given by your surgeon and only takes a few minutes. A dressing is placed over the injection site and you can go home30 minutes after the injections. (Delete) You will need to come back 24-48 hours later for a finger extension manoeuvre, where the bent finger is straightened out in order to break the fibres in the thickened fascia. This (delete) is usually done under local anaesthetic.
After the finger straightening, you are encouraged to move it as much as possible.A hand therapist will see you to fit a resting thermoplastic splint to reduce the chance of recurrence.
How many injections are needed?
You will need to be checked (delete) a monthfollowing the procedure to see if further injections are needed. A maximum of three injections may be given every 4–6 weeks, but further injections are not usually required.
Are there any complications?
Serious complications are rare (<2%). The most commonly reported complications are swelling, pain and bruising at the site of the injection.
Dupuytren’s disease surgery
What is Dupuytren’s disease surgery?
There are different types of surgery including:
- cutting the thickened fascia (fasciotomy), which can be done either during open surgery (described below) or using a needle through the skin
- removing the abnormal thickened fascia (fasiectomy)
What is involved?
Surgery is usually performed under a general anaesthetic as a day procedure. It takes between 30 and 60 minutes to perform. A tourniquet is placed above the elbow to ensure a bloodless field. A zigzag incision is made along the palm and out to the finger. Skin flaps are elevated and the tendons, nerves and arteries are identified and protected. The cord causing the contracture is identified and removed. Occasionally, a skin graft may be required if there is a significant skin defect on closure of the skin flaps. The skin is sutured closed and dressings and a plaster cast is applied.
The hand is immobilised inside the cast for 3-5days. The wound is inspected 3-5 days after surgery and the sutures are usually removed 10–14 days post-surgery.
What happens after surgery?
After the sutures are removed, a splint is organised by your hand therapist to avoid early recurrence of the contractures. A separate splint is also organised to be worn at night for a further 3 months. You will be able to return to most activities of daily living once the sutures have been removed. You can to return to light work environments once the sutures have been removed, but heavy manual labour is often delayed for 4–6 weeks.
Are there any complications?
More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes.
Some complications specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1-2% chance), which is a reaction to surgery that can cause painful or stiff hands.
Complications specific to Dupuytren’s contracture surgery include recurrence. This is common, but it may not occur to the level that requires further surgery. Occasionally, the surgery is unable to completely straighten the finger, especially in recurrent disease. Sometimes blood vessels and nerves to the finger may be damaged and leave one side of the finger numb or alter the blood supply to the finger. There may be specific wound breakdown of more complex incisions and more advanced disease