Problems of the hand and wrist can occur at anytime. Unfortunately, loosing the range of motion in the hand can hamper how we perform at work, at home, and during recreation. It may be hard to grab a coffee cup, type on a computer, or even hold a pencil. Luckily, treatment is available to restore function of the hand and wrist, allowing patients to comfortably return to their daily activities.
What is Dupuytren’s Contracture?
Dupuytren’s Contracture is a commonly occurring flexion contracture of the hand, characterized by fingers that bend towards the palm and cannot be straightened. The condition causes the deep tissues of the hand (palmar fascia) to become thick and short, restricting the movement of tendons attached to each finger. Patients with Dupuytren’s Contracture cannot straighten the fingers, lose ability to put the hands in the pockets, and eventually lose the capacity to tightly grip objects.
Dupuytren’s Contracture is seen in more men than women, with an increased incidence over the age of 40. The progression is slow and painless, possibly going unnoticed at first. The condition primarily affects the little, ring, and middle fingers; but rarely the index finger or thumb. Nodules are sometimes seen forming in the palm, as well as thick bands of tissue under the skin. The only intervention for Dupuytren’s Contracture is medical management, without which the condition will steadily progress.
Causes of Dupuytren’s Contracture:
The exact cause of Dupuytren’s Contracture is not known. However, injury and heavy hand use has not been shown to trigger the condition. While not always present, there are several factors that may put people at a greater risk for developing Dupuytren’s Contracture.
- More common in people of Northern European or Scandinavian ancestry.
- It is often hereditary, passed down from generation to generation.
- Associated with increased alcohol consumption.
- Seen with other medical conditions, such as diabetes or seizures.
- Incidence increases over the age of 40.
- Occurs more in men than women.
The Ideal Candidate for Treatment:
Anyone troubled with a known case of Dupuytren’s Contracture, or experiencing signs and symptoms of the disease, may benefit from treatment. The ideal patient will be in relatively good health, have a clear understanding of the condition, and hold realistic expectations for treatment. Each potential patient will have a one-on-one consultation with Dr. Whipple to determine if treatment is right for the individual.
The Consultation Appointment:
Prior to beginning treatment, a visit will be arranged with the surgeon. Here, Dr. Whipple will perform a quick physical examination, looking at the anatomy of the hand, and measuring movement of the fingers or wrist. Dr. Whipple will also review medical history, current medications, and goals for treatment. Finally, he will go into great detail about Dupuytren’s Contracture and the therapeutic options available. If it is determined that medical intervention can be beneficial, a treatment plan will be created specifically for you.
The Correction of Dupuytren’s Contracture
Unfortunately, there is no way to cure or halt the progression of Dupuytren’s Contracture. However, a remarkable amount can be done to ease the symptoms and manage the problems associated with Dupuytren’s Contracture. About 20% of patients will experience a reoccurrence of the condition after the initial treatment.
Treatment Options for Dupuytren’s Contracture:
Noninvasive (2 options):
- Enzyme injection – An enzyme that breaks down protein is injected into the Dupuytren’s cord. The following day, Dr. Whipple will straighten the involved finger to break the cord, usually with local anesthesia for comfort. A splint will be applied for about 3 weeks.
- Steroid Injections – An injection of a corticosteroid (an anti-inflammatory medication) may relieve pain associated with a lump or nodule. In some cases, a steroid injection will temporarily halt the progression of contracture.
Surgical Correction – Surgical treatment for Dupuytren’s Contracture is designed to divide or completely remove the thickened bands of tissue under the skin, restoring finger motion. Skin grafting may be required after surgery for proper healing.
The recovery from surgical intervention will take several weeks. Some swelling and soreness may be experienced. Physical therapy may be helpful at this time, to recover a full range of motion, and to strengthen the hands or fingers. Complications from surgical treatment are rare but can include a stiffness of the fingers, injury to the nerves or blood vessels of the hand, and infection.
New noninvasive treatments for Dupuytren’s Contracture are continuously being developed. One cutting-edge procedure includes enzyme injections, as discussed above, designed to break down the tough bands and release contraction. Needle aponeurotomy shows some promise as it utilizes a thin needle to divide up the diseased tissue. Both of these can be performed in the doctor’s office with few complications.
Hillelson-Whipple Clinic offers patients a variety of payment options. We accept cash, all major credit cards, and healthcare financing through CareCredit. Some treatments may be covered by your medical insurance; your patient coordinator will be happy to help determine your benefits.
About the Surgeon:
Dr. Terry Whipple is a Board Certified Orthopaedic Surgeon, with over 30 years of experience. He is an alumnus of Princeton University, and received his MD from the University of Virginia. He performed his residencies at Baylor College of Medicine and Duke University Medical Center. Dr. Whipple is considered a leader in orthopaedic medicine and is the top surgeon treating Dupuytren’s Contracture today. Dr. Whipple founded Hillelson-Whipple Clinic Plastic Surgery and Orthopaedics, along with Dr. Ruth Hillelson.
Do you still have questions about Dupuytren’s Contracture? Call Hillelson-Whipple Clinic at 804.290.0060 to find out more about this condition and the treatment options or fill out our contact form. We can assist in scheduling a complementary consultation appointment with Dr. Whipple or Dr. Hillelson. Our office is located in beautiful Richmond, Virginia; conveniently close to Washington DC, Charlottesville, and Newport News. If you require travel assistance, help with accommodations, or transportation services, please let us know.