Clinical treatments – Dupuytren’s contracture
If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you may not need treatment. Instead, you may choose to wait and see if Dupuytren’s contracture progresses but concentrate on the massage and use of the relief balm.
Treatment involves removing or breaking apart the cords that are pulling your fingers in toward your palm. This can be done in several different ways. The choice of procedure depends on the severity of your symptoms and any other health problems you may have.
This technique uses a needle, inserted through your skin, to puncture and “break” the cord of tissue that’s contracting a finger. Contractures often recur but the procedure can be repeated. Some doctors now use ultrasound to guide the needle. This might reduce the chance of accidental injury to nerves or tendons.
The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. The main disadvantage is that it cannot be used in some locations in the finger, because it could damage a nerve.
The Food and Drug Administration has recently approved injections of an enzyme, collagenase clostridium histolyticum (Xiaflex) for the treatment of Dupuytren’s contracture. The enzyme in this drug softens and weakens the taut cord in your palm. The day after the injection, your doctor will manipulate your hand in an attempt to break the cord and straighten your fingers.
In many ways, this is similar to the needling technique, except that the manipulation happens the next day, instead of during the injection procedure. The advantages and disadvantages of the enzyme injection are similar to needling, except that the enzyme injection may be more painful initially. Currently, enzyme injections can be used on only one joint at a time and treatments must be spaced at least a month apart.
Radiotherapy is a non-surgical treatment that can stop or slow down Dupuytren’s disease in its early stage. In radiation therapy, the nodules and cords associated with Dupuytren’s are irradiated from a distance of .5 – 1 cm either with X-Rays (e.g. 120 kV = soft X-Rays that do not penetrate deeply into the body) or with electrons (3 – 10 MeV). This is typically done over five days in a row ( total dose 15 Gy). After a break of six weeks, this treatment is repeated.
Another option is to surgically remove the tissue in your palm affected by the disease. This may be challenging because it’s difficult to identify tissue in very early stages of the disease. Diseased tissue may also attach to the skin, making it difficult to remove and increasing the chances of recurrence.
The main advantage to surgery is that it results in a more complete joint release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and the recovery time can be longer.
In some severe cases, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases a skin graft will be needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward.