How Dupuytren’s Contracture Is Treated Everyday Health MenuNewslettersSearch Living With Dupuytren s ContractureDupuytren's Contracture How Is Dupuytren s Contracture Treated If you have this connective tissue disorder, you may experience hand deformity, which can interfere with daily activities. Learn what treatments are available and which may be right for you. By Jessica MigalaMedically Reviewed by Robert Jasmer, MDReviewed: March 22, 2021Medically ReviewedThe treatment option you and your doctor choose will depend on your syptoms and stage of disease.ShutterstockDupuytren’s contracture is a deformity of the hand that results when fibrous connective tissue called fascia begin to thicken in the palm and fingers. “Patients develop greater and greater amounts of scar tissue that can pull on itself, or contract. Unlike a rubber band that can snap back, this tissue ends up getting tighter and tighter,” explains Daniel Osei, MD, a hand and upper extremity orthopedic surgeon at the Hospital for Special Surgery in New York City. Eventually, this tissue may thicken and develop into cords that pull one or more fingers down toward the palm, making it difficult to straighten the hand. There are risk factors for Dupuytren’s, such as smoking or having diabetes or high cholesterol, but by and large, “The condition can’t be prevented,” says Alejandro Badia, MD, an orthopedic hand surgeon at the Badia Hand to Shoulder Center in Doral, Florida, near Miami. Although doctors aren’t sure exactly what causes the condition, it’s believed to have an inherited/genetic component, because it often clusters in families, according to the American Academy of Orthopedic Surgeons (AAOS). Deciding When and How to Treat Dupuytren s Contracture There’s currently no cure for Dupuytren’s contracture, but treatments can help slow the progression of the disease and relieve some of the troublesome symptoms, including the inability to open your hand completely to perform routine tasks, such as washing your face or putting on gloves. Dupuytren’s begins as a bump or hard spot in one of your palms. In some cases the condition may not progress beyond the development of these nodules or even go away on its own without treatment, but in most people Dupuytren’s gets worse over time, according to the U.S. National Library of Medicine. “It’s a complex genetic disorder, but not everyone shows the full spectrum of disease; some people have mild symptoms, while others have more severe disease,” Dr. Osei says. “Over time, we will learn more about who’s at risk, but right now, we don’t really know,” he adds. Some factors may be associated with more aggressive disease, though, according to the Dupuytren Research Group. These include having a family history of Dupuytren’s contracture, developing the condition before age 50, or having a related condition, such as Ledderhose disease, which causes similar connective tissue buildup and hardened lumps on the bottoms of the feet. Whether your doctor recommends treatment, and if so, what type, depends on how serious your condition is, how much it impacts your daily life, whether your symptoms are expected to get worse, and your overall health, according to Johns Hopkins Medicine. If you only have some bumps in your hand and they’re not causing discomfort or interfering with daily activity, you may not need treatment, according to AAOS. But if you are unable to lay your hand flat on a table, Osei says, you will likely need to be treated. Your doctor will measure the angle of your hand relative to your fingers. If you develop a severe contracture of more than 20 to 25 degrees, it’s time to consider an intervention, he says. Doctors usually recommend starting with minimally invasive nonsurgical treatment and then moving to surgical options if necessary, according to the Dupuytren Research Group. Surgery is usually recommended for people who have severe contractures, are likely to develop more serious disease, or continue to have symptoms after minimally invasive treatment. As noted in a study published in May 2017 in the journal PLoS One, since the treatment options we have today can only treat the symptoms of Dupuytren’s contracture, which is a chronic and progressive disease, recurrence over time is inevitable for most people. Treatment Options for Dupuytren s Contracture There are three main treatments being used today for Dupuytren’s contracture: enzyme injection, needle aponeurotomy, and surgery. The first two options are minimally invasive and can be performed in the surgeon’s office under local anesthesia, according to the Dupuytren Research Group. The procedure that’s best for you will depend on the severity of the contracture, the specific area of the hand involved, your overall health, and cost. Enzyme injections In the past, doctors would wait longer to treat Dupuytren’s, until it was at such an advanced stage that it required surgery. Today, they can intervene earlier using newer nonsurgical techniques, such as enzyme injections, which can lead to faster recovery and possibly better control of the disease. “The enzymatic injection has greatly changed the way we think about Dupuytren’s contracture,” says Osei. During this procedure, an enzyme called collagenase clostridium histolyticum (Xiaflex) is injected into the cord in your palm to soften and weaken it. “The enzyme works by breaking down the cord,” says Osei. You then come back to the office a day or two later, at which point your doctor will move your hand to break the cord and enable you to straighten your fingers. As with any treatment, there are pros and cons. The biggest advantages over surgery are that there’s no cutting involved, there’s a lower risk for complications, and recovery time is much shorter, according to the Dupuytren Research Group. But there are also some downsides. Depending on the location of the contracture, there may be a greater risk of injuring a nerve or blood vessel in your fingers, says Osei. And compared with surgery, recurrence rate of the disease is much higher for nonsurgical treatment. According to the Dupuytren Research Group, surgical treatments keep symptoms from returning twice as long compared with minimally invasive treatments. And an article published in December 2018 in The Journal of Bone and Joint Surgery notes that when defined as a loss of extension of 20 degrees or greater , the recurrence rate was between 27 and 56 percent three years after injection; the article also cites a 5-year follow-up study showing that when it was defined as at least 30 degrees’ loss of extension, 85 percent experienced a recurrence. Another downside, notes Dr. Badia, is that enzyme injection can be expensive. According to a study published in October 2020 in JAMA Network Open, enzyme injection is the least cost-effective treatment when compared with needle aponeurotomy (another nonsurgical procedure discussed below) or surgery for recurring contractures. Other studies have found that enzyme injections may actually end up costing less. A study published in February 2019 in the Journal of Hand Surgery Global Online that evaluated the total cost for a 3-month period of posttreatment care after enzyme injection found that enzymatic treatments were associated with a 12 percent reduction in the total cost of care compared with surgery. Needle aponeurotomy In this nonsurgical outpatient treatment, you receive an injection of anesthetic in the area with the Dupuytren’s cord. Your doctor then takes a small needle and perforates the cord so it can snap, allowing your fingers to straighten. “This is much like breaking up a rope with a jagged rock,” says Osei. After this procedure, you should be able to go back to work within 48 hours, notes Cleveland Clinic. But as with enzyme injections, the odds of the disease recurring are high. According to Cleveland Clinic, the contracture returned within 2 years in half of the people treated with this procedure. Surgery Your doctor will likely gauge whether you should be treated with surgery based on how serious your Dupuytren’s contracture is. “To me, the severity of the contracture is the biggest criteria,” Osei says. Surgery usually involves making cuts to the skin in the affected areas of the palm and fingers to remove the diseased tissue, a procedure called a fasciectomy. In some cases, doctors may make incisions to release the affected area but not remove it (called a fasciotomy), or in severe cases, remove the entire area, including portions of the skin of the palm (called a dermofasciectomy). The main advantage of surgery is a lower rate of recurrence compared with nonsurgical treatments for Dupuytren’s, while the biggest downside is a higher risk of complications and longer recovery. According to Mayo Clinic, people usually need months of intensive physical therapy after surgery for Dupuytren’s contracture. Everyone heals differently, and some may experience more swelling or discomfort than others, but by 8 weeks postsurgery, the majority of patients are able to do most activities, says Osei. It’s important to mentally and physically prepare yourself for recovery to ensure the best outcome possible. More in Dupuytren' s Contracture Are You a Candidate for Nonsurgical Treatment for Dupuytren s Contracture 6 Signs You May Have Dupuytren s Contracture Living With Dupuytren s ContractureNEWSLETTERS Sign up for our Healthy Skin Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. 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