Dupuytren's Disease: Should I Have Hand Surgery?

Dupuytren's disease (say "duh-pwee-TRAHNZ") is an abnormal thickening of tissue beneath the skin in the palm of the hand. The first symptom often is a small lump (nodule) in the palm, often near the base of the fingers. In some people, a fibrous cord may form in the palm tissue. The cord pulls the finger toward the palm. This is called Dupuytren's contracture.

If the disease gets worse, over time you may not be able to flatten your palm on a flat surface, such as a table. Severe forms of the disease can make everyday activities, such as picking up items, putting on gloves, or washing hands, difficult or impossible.

There are two types of surgery that can help you use your hand again:

• Fasciectomy is the most common surgery. It involves removing the thick and fibrous tissue beneath the skin of the palm.
• Fasciotomy is less common. The surgery involves using small cuts to divide the cords of fiber in the palm. It is only done in people who aren't likely to benefit from fasciectomy or whose disease has come back.

Delaying surgery until your condition is severe—for example, waiting until you are unable to use your hands to do daily activities—could make the surgery and your recovery harder.

• In mild cases of the disease, regular stretching of the fingers may be enough to keep the use of your hand. Twice-daily sessions of massaging the hand and gently stretching your fingers back relieves tightness and helps keep your fingers flexible. A physical therapist or occupational therapist can show you range-of-motion exercises that may help. Sometimes splints are used to try to slow the progress of the disease. But there is not much evidence that using splints or stretching the fingers helps.
• Shots of lidocaine or steroid medicine or both may relieve symptoms for a while.
• A collagenase injection (such as Xiaflex) may dissolve some of the tight tissue.
• Needle aponeurotomy uses a needle to separate the tight cords in the palm, so no cuts are made in the palm.

Complications after surgery for Dupuytren's disease occur in about 1 out of 5 cases.¹ Problems can include:

• Delayed wound healing. This is the most common problem, and it is often mild.
• Infection of the wound.
• Stiffness or contracture, with the fingers still being curled.
• Damage to the skin, caused by trying to surgically separate the skin from the fibrous tissue.
• Reflex sympathetic dystrophy.

Surgery can improve, but may not completely restore, the use of your hands. And it can't cure the disease. The disease comes back after surgery nearly half the time. Even after a successful surgery, you may need another surgery later to keep the use of your hands.

Home treatment and physical therapy are important to the success of your surgery.

Exercises

A physical or occupational therapist can teach you how to do exercises to gently move your fingers through their normal range of motion. These exercises help prevent stiff joints. Range-of-motion exercises should not stress or overextend the joint.

Splints

Splints may be used after surgery for about 8 to 10 weeks to help restore the use of the hand and keep symptoms from coming back. Splints support your palm and help straighten your fingers during recovery.

In some cases, splints are worn only at night, but in others they are worn at all times, except when the wound needs cleaning or during finger exercises. Your doctor can teach you how and when to wear the splint.

Your doctor might suggest surgery if:

• You have tried other treatments but your fingers are increasingly bent to the palm and you can't flatten your hand.
• You have pain from nodules.