By Julia Guthart, OTR/L CHT
Dupuytren’s Contracture Overview
Dupuytren’s contracture is a disease or condition where a tissue layer in the palm beneath the skin becomes thicker and tightens. This normally elastic tissue can then contract and become a rigid Dupuytren’s cord that runs from the palm to the fingers. These cords shorten over time and force the fingers to flex. This can become progressive and limit the ability to extend the involved fingers and lead to significant deformities. The ring and small fingers are involved more frequently, but any of the digits can be affected.
This condition occurs primarily in families of Northern European descent. It is more commonly seen in men over the age of forty. It often begins first as lumps or nodules in the palm and can then progress to cords and finally to the contracture where the fingers are bent. This can make it difficult to place the hand flat on a table, wear gloves, type on a keyboard or retrieve coins from a pocket.
An Option for Dupuytren’s Contracture: Needle Aponeurotomy
A procedure called needle aponeurotomy is an option for the treatment of this condition. It is often chosen over surgical excision of the cord as it is less invasive, has a shorter recovery time and fewer risks. There is also a significantly lower cost. After numbing and cleaning the hand, the needle is introduced into the cord and its sharp tip is used to create a division, such that the cord is no longer in continuity. Usually the finger can then be extended.
The puncture hole or holes that are created with the needle are simply covered with an adhesive bandage. There are times when the skin over the cord is too tight. When this occurs, the extended finger skin spreads open along with the cord and a skin tear is created. In this case, care of this wound must be performed, but in general it fully heals over the next two weeks and does not diminish the results of the Needle Aponeurotomy.
The outcome for most patients is quite good, with the majority of patients having significantly improved function. Certainly not all fingers achieve full extension and some cases are not appropriate for this treatment method. It is also quite clear that the genetic condition is not cured with this treatment and recurrence is a notable risk. If it does recur, which generally takes years, this procedure can be considered again, or other procedures may be entertained.
What happens after the procedure? Are there special exercises for Hand Therapy?
After the procedure, patients are referred to the Hand Therapy department for a night time splint to be worn on the involved hand keeping the fingers in an extended (or straight) position. It is important to wear this splint at night because this helps prevent a recurrence of the contracture. Sleeping without a splint permits the fingers to curl up, as they do for all of us. By wearing this splint, the patient assists in the remodeling phase of healing. During the day the hand is used normally. If a skin tear occurs during the release, the patient may be referred for formal hand therapy.
These visits may include bandage changes or whirlpool to promote skin healing. Moreover, specialized exercises to facilitate extension of the fingers and functional grip and pinch will be provided. However, most patients do not need formal therapy following this procedure; after receiving the custom-made thermoplastic splint, patients will be provided with these exercises to perform independently at home.