Dupuytren's Needle aponeurotomy

Dupuytren’s Contracture

This condition runs in families, but each individual will have a different experience of it. Some people will have recurrent trouble and need treatment each 5 to 10 years, while in others one or no treatment may be enough.

When Dupuytren’s contracture involves the hand, nodules under the skin develop, which may coalesce, and become bands that run toward and into the fingers. Those bands can tighten, and draw the fingers into a permanently bent position. The tissue that develops lies among the normal fibrous strands that form a sheet under the skin of our palm and fingers: small strands run to the skin and stop it from slipping around that normally helps us grip implements and objects.

You can find out more about Dupuytren's Contracture on the International Dupuytren Society's website.

Diagnosis:

This condition is common amongst Australians: particularly those with Anglo-Saxon heritage (the Vikings genes!). So most local doctors and surgeons can confidently diagnose Dupuytrens.

Sometimes single nodules, or single tight joints can be confusing to diagnose. It usually does not need ultrasound, xray, MRI etc to be correctly identified.

Treatment:

With some people in the early stages, massage and stretching of the areas of active nodules or cords may slow the progression of the condition. Wearing splints while sleeping can straighten fingers sometimes. Certainly the opposite: i.e. holding the hand continually in a closed fist, in cold conditions will make the condition develop more rapidly.

Some painful nodules may be eased by an injection of anti-inflammatory steroid into them.

Joint contracture:

Surgical treatment should be considered if the hand can not be laid flat on a table-top. Try to seek treatment at this time, as prolonged contracture of the small joints is harder to repair.

Percutaneous Needle Fasciotomy: PNF

Simple cords can often be treated under local anaesthesia with this needle release procedure. Most early bands are suited to this technique, Results are immediate and recovery very quick: unless there is a skin tear the puncture seals within a day or two.

At a week after release, at the appointment for review the progress is checked, and the hand therapist shall make a custom splint for night wear to help keep the stretch through the early healing phase for the next 6 to 8 weeks, and arrange exercises and therapy treatment as may be needed.

This is still a skilled treatment: the bands entwine with nerves and tendons: and so damage is risked: but infrequent.

Unfortunately it will come back though: as is the case with all Dupuytren’s: this is an inherited condition that may affect any part of the hand and fingers. At 3 years after PNF 40% of people will need further help.

Limited Fasciectomy: LF

Formal surgical removal of the cords and release of contracted joints remains a frequently needed treatment. Dupuytren’s involvement in the finger is usually too risky to release with a needle: the nerve is too closely enveloped in the tissue, and sometimes the palmar disease is over too wide an area to respond to limited needle release.

In Adelaide, our cold winter climate can make surgical recovery slow after this procedure: joints stiffen and blood flow slows in the hand. Some people can get the ‘flare’ reponse: their scar that forms is very aggressive and tries to contract the skin and joints again.

So, I and the hand therapists of this practice are very familiar with all the manoeuvres to help your recovery proceed rapidly: many lucky people form soft scar and flexible joints quickly. Others may need all the tricks to reach their best outcome.

- Philip A. Griffin, FRACS