Dupuytren Disease: Treatment Options

Dupuytren Disease: Treatment Options

This video will provide an overview of surgical and nonsurgical treatment options for Dupuytren disease, a condition impacting the connective tissue of the hands. In Dupuytren disease, collagen, a protein found in the hands' connective tissue, is overproduced. This leads to the formation of nodules and cords in the connective tissue within the hand and fingers, which can cause contracture or tightening of the tissues. Over time, this abnormal tightening can lead to curling in the fingers and palm.

Dupuytren disease is progressive, meaning it will worsen with time. No preventative treatments have been proven to stop the condition's progression. Ongoing monitoring with a hand specialist is needed. The decision to treat the condition is based on the severity of contracture in the hand and the functional limitations a patient may have.

Nonsurgical treatment methods for this condition include office-based procedures. A procedure called a needle aponeurotomy may be recommended. Here, a local numbing medication is used for pain relief, and a small needle is used to make holes in the cord in multiple spots, which weakens and breaks up the cord. Early in the disease, a corticosteroid injection may be offered to reduce nodule size and pain. These injections may only provide temporary relief.

Therefore, another in-office treatment that has become more popular in the past decade is a collagenase injection, which may be given with local numbing medication. Collagenase is an enzyme that breaks down collagen and weakens the connective tissue. Speaker1: The collagenase is injected directly into the cord. Following the injection, the patient will return to the office a few days later to have the health care provider gently pull the finger to the desired position, which is called a manipulation. This portion of the procedure breaks apart the cord and releases the contracture.

Hand therapy and bracing will likely be ordered following either procedure to prevent the problem from recurring. Surgery will be considered when the condition has advanced and hand function is significantly limited by the degree of contracture noted. Surgery for this condition is called a fasciectomy. Fascia is the connective tissue and "ectomy" means removal. The extent of the fasciectomy, or removal of the connective tissue, is dependent on the severity of each condition.