Dupuytren Disease Treatment

Dupuytren Disease is a hereditary condition that causes abnormal thickening and shortening of connective tissue in the hand that is characterized by a hard nodule or cord in the palm.  This may lead to formation of a Dupuytren Contracture which is when the finger becomes stuck in a flexed position.  Although there is no cure for Dupuytren Disease, the expert hand surgeons at Hand Surgery of Los Angeles can help to minimize and manage the effects of this disease with the most advanced treatments available.

Dupuytren Disease is sometimes referred to as a “Viking Disease” because it is most common in those of northern European descent.  While this is certainly true, Dupuytren Disease may be found in people of all ethnic backgrounds.  The disease is passed in the genes through family generations.  In addition to the hands, Dupuytren Disease may affect the feet and penis as well.  

What to look for

Dupuytren Disease most commonly affects the ring and little fingers, however it can affect all fingers.  Early disease presents with firm nodules or cords that can be felt in the palm.  As the disease progresses, you may notice curling or “contracture” of the fingers.  This is most commonly present at the first knuckle (MCP) and/or second knuckle (PIP) or between the thumb and index finger. 

Treatment

The surgeons at Hand Surgery of Los Angeles are highly experienced at managing all stages of Dupuytren Disease. They offer the most advanced surgical and minimally invasive treatments for this disease and will provide a careful, individualized approach to your disease.  

Early disease with no finger contracture is generally managed with stretching exercises and close monitoring.  There is generally no indication for surgery or injections if you can fully straighten your finger.   It is very important that you see a hand surgeon as soon as you notice any curling or contracture of your finger.  This is generally much easier to treat at an early stage than after the contracture has become very severe.

Surgery

Surgical removal of the thickened cord is the mainstay of Dupuytren Disease management.  This is indicated for severe or complicated contractures.  An extensive incision is made over the thickened area and the diseased tissue is very carefully freed from the surrounding tendon, nerves, and blood vessels.  You surgeon will likely prescribe a course of hand therapy after surgery as well as some nighttime splinting.

Xiaflex Injection

Xiaflex is an injectable medication that dissolves the abnormal connective tissue.  This treatment may be used for many early and intermediate stages of contracture, however a thorough discussion with your hand surgeon is necessary to determine if your disease is appropriate for this treatment.  Xiaflex is injected in the office directly into the thickened cord in the hand.  You will then return to the office 1-3 days later at which time the surgeon will manipulate and straighten your finger, thus breaking the cord.  This treatment has much less downtime than surgery, however skin tears are possible that require some wound care.  

Needle aponeurotomy

Needle aponeurotomy is a procedure where your surgeon will break apart the thickened cord using a hypodermic needle.  This is generally only indicated for very simple and easy to feel cords.  This procedure is performed in the operating room in a single stage.  Although quite successful at breaking the diseased tissue and allowing for a straight finger, the procedure does not remove any of the thick tissue.