What to Expect After a Dupuytren's Contracture Diagnosis
Dupuytren’s disease, as it’s sometimes known, is a chronic condition affecting the tissue beneath the skin on the palm of your hand and fingers, called the fascia. Dupuytren’s contracture can result in one or more of your fingers on one or both of your hands curling up into your palm, with no way for you to straighten out the finger or fingers. The bending of your fingers is called Dupuytren’s contracture. However, it’s not the first sign of Dupuytren’s. Oftentimes, earlier signs and symptoms of the condition send people to the doctor well before the contracture occurs or is noticeable.
Early Symptoms of Dupuytren’s Contracture
Your first signs of Dupuytren’s disease are likely to be a lump or nodule in the palm of your hand. The nodule might be swollen, sore or itchy. Other signs include a puckering in the skin of your palm, which also might be tender or have burning or itching sensations. Your hands may feel clumsy.
Your primary care doctor may be the first provider to examine your hands and evaluate these early symptoms. They’ll also take into consideration your family history, which is key, since Dupuytren’s contracture runs in families. Your primary care doctor may diagnose you directly, or may refer you to a hand specialist for a formal Dupuytren’s contracture diagnosis. In either case, you will likely need a hand specialist to discuss next steps and treatment options.
Dupuytren’s Contracture Progression and Early Treatments
Dupuytren’s is a chronic condition, meaning it worsens with time. Some people have more mild disease that progresses slowly over many years. They develop nodules and other symptoms, but do not experience a significant hand deformity. The other end of the scale is people who experience symptoms early in life. They are more likely to have an aggressive form of the disease with deformity and loss of hand function.
A hand surgeon who has been specially trained in Dupuytren’s disease can provide the best expertise in the most up-to-date treatments and medications. Your doctor may recommend treatment for the nodule or your other symptoms—before signs of contracture. A biopsy or removal of the mass in your palm is not recommended because it could inflame the area and hasten the onset of contractures.
Disease management options to discuss with your doctor include:
- Cortisone injections: Injecting cortisone directly into the nodules can help relieve inflammation, reduce pain, and even make the nodule go away. Treatment relief is likely to be temporary because Dupuytren’s is a chronic condition. you may need to have these shots repeated at regular intervals.
- Radiation therapy: Sometimes if you have a significant family history and your disease seems aggressive, low-energy radiation as a non-standard treatment may be an option. It is more common outside the United States, but research does indicate low-dose radiation can help alleviate some symptoms in early stage patients.
- Watching and waiting: Your doctor likely will ask you to watch your hand for the development of contractures (finger bending). One way to check at home is to press your hand flat on a table and see if your palm lays flat. If you do this every month or so, you can catch any contracture early and bring it to your doctor’s attention. Your doctor also will want to see you at regular intervals.
- Make lifestyle changes: While there is no diet, exercise or supplement proven to delay onset of Dupuytren’s contractures, you may be able to reduce some of the possible triggers of the disease, including heavy drinking and smoking. If you have a family history of Dupuytren’s, limit alcohol and do not smoke. You also may want to avoid heavy manual labor that would put a lot of stress on your hand (more than two hours per day), or use padded grips to protect your hand.
In the past, hand splints and aggressive stretching exercises were tried as a way to keep fingers straight. However, research has shown these measures could further inflame the affected tissue and cause or worsen contractures. Research about Dupuytren’s contracture massage treatment is minimal, but researchers are concerned aggressive massage might do more harm than good. Your hand specialist is a good resource to ask about what type of massage, if any, you might consider.
Dupuytren’s Contracture Treatment
If you see contracture beginning, visit your doctor. Ideally, surgeons would like to begin procedures when your contracture is at an early stage, between 20 and 40 degrees. Contractures can be treated at any stage—even the most severe. However, treatment early on in the disease process has the most promise for a good outcome. Your doctor may suggest one of these most common treatments for Dupuytren’s contracture.
- Open surgery (fasciectomy) surgically removes diseased tissue (fascia) so the finger can straighten. Open surgery provides a longer time before recurrence happens, with about half of patients having a recurrence by 10 years (and half recurrence-free after 10 years). The recovery period is about 12 weeks and involves physical therapy afterwards.
- Needle aponeurotomy (also known as needle fasciotomy) uses a needle to cut the cord that is contracting your finger. The surgeon uses a local anesthetic to numb the area. Recovery is much quicker than with open surgery and there are fewer complications. It is half as effective as surgery for recurrence: About half of patients have a recurrence within five years. Physical therapy is part of recovery, which is typically shorter than with open surgery.
- Collagenase injection is a two-step, minimally invasive procedure in which the surgeon injects the cord with an enzyme (brand name Xiaflex), which softens the fascia. One to 3 days later, you go back to the surgeon, who manipulates your fingers until the cord snaps and the fingers straighten. Physical therapy, complication rate, recovery time, and contracture recurrence rate are similar to needle fasciotomy.
Discuss the pros and cons of each procedure with your doctor to help determine your best path forward. Ask the surgeon about your personal risk of complications and likelihood of recurrence.
Dupuytren Disease Research Effort
Treatment can only alleviate symptoms of Dupuytren’s contracture; they can’t cure the underlying disorder, which means recurrence is likely. Researchers are trying to find out more in the hopes of one day having a cure. The International Dupuytren Data Bank is seeking help—in the form of surveys and blood samples—from both people with Dupuytren disease and those without it. If you’re interested, more information is available at https://dupuytrens.org/enroll-in-the-iddb/.