Restore Movement and Straighten Fingers with Effective Dupuytren’s Contracture Treatment
Dupuytren’s contracture, also called Dupuytren’s disease, is a progressive condition that can restrict hand movement by causing one or more fingers to bend inwards toward the palm. This bending results from thickened abnormal fascial tissue forming beneath the skin in the palm and fingers, which over time leads to the development of fibrous cords that pull the fingers into a bent position.
UK Hand & Wrist Surgery, led by Specialist Hand Surgeon Mr Patrick Goon, offers advanced surgical treatments to address Dupuytren’s contracture, focusing on improving hand functionality and quality of life.
Understanding
Dupuytren’s Contracture
Dupuytren’s contracture is a disorder where thick cords and nodules develop in the palm and fingers, pulling affected fingers – often the ring and little fingers – into a fixed bent position. Initially, patients may notice small lumps in the palm, but as the disease advances, these nodules harden and form thick cords, restricting finger movement. Contrary to public perception, it is not a tendon problem.
Although the exact cause is unknown, it is commonly associated with a family history and generally affects individuals as they age. Left untreated, Dupuytren contracture can worsen, leading to severely bent fingers that interfere with daily activities.
Symptoms of Dupuytren’s Contracture
Early detection of symptoms can be key to managing Dupuytren’s disease effectively. The symptoms often begin subtly but may progress as the affected tissue thickens and tightens. Recognisable signs include:
- Thickened Tissue and Nodules: Small lumps in the palm may develop into thick cords under the skin. Initially, lumps can be tender.
- Bent Position: Affected fingers, usually one or more fingers, are gradually pulled into a bent position toward the palm. This is accurately termed flexion contracture.
- Difficulty with Daily Tasks: Activities that require hand function, such as straightening fingers, holding objects, putting on gloves, become increasingly difficult.
- Advanced Symptoms: In more severe cases, the affected fingers become fixed in a bent position, significantly restricting hand function. Joints can become permanently fixed, and finger deformities with tendon imbalances may complicate the picture.
Dupuytren’s contracture surgery helps relieve the symptoms of thickened cords that restrict finger movement and hand function.
Diagnosing Dupuytren’s Contracture
To diagnose Dupuytren’s contracture accurately, a specialist performs a physical examination to evaluate the appearance, as well as the symptoms and to determine the extent of finger bending or contracture. A thorough assessment of the nodules, the degree of contracture in the affected fingers and finger joint involvement helps establish the condition’s severity.
Very occasionally, imaging tests may be useful in order to understand the overall anatomy better, but this is usually when there is concurrent other pathology involved.
Treatment Options for Dupuytren’s Contracture
Treatment for Dupuytren’s contracture varies based on the progression of symptoms. In mild cases, non-surgical interventions may be considered, while more advanced stages may require surgical treatment to restore function. Surgery needs to be performed with the utmost care and precision, as the disease tissue quite often runs in planes that intimately involve the tiny nerves and blood vessels to the fingers. Inadvertent damage to these important structures may result in permanent numbness or pain, and even loss of digits in extreme scenarios.
Therefore it is imperative that patients put their trust in technically experienced microsurgery hand surgeons to do their surgery, who are well versed in using loupe magnification and performing microsurgery. The risk to these minute structures goes up exponentially when previous surgery has already occurred in the digits as there is significant scarring and loss of tissue planes. In the unlikely event that these tiny structures are damaged during surgery, the ability to confidently repair or reconstruct them immediately is essential. Patients need to be ready to inquire of their surgeons whether the latter are experienced microsurgeons in their practice.
Non-Surgical Treatments
In the early stages, physical therapy and hand therapy exercises may help maintain mobility in the affected fingers. While these methods cannot halt progression, they can assist in keeping the hand as flexible as possible.
Fasciotomy and Fasciectomy
These surgical options involve cutting or removing the diseased tissue to release the contracture. Fasciectomy is commonly used for more advanced cases, removing all the tissue involved in the contracture.
Dermofasciectomy with Skin Grafts
For cases where extensive diseased tissue is present, including skin involvement, excision of diseased skin followed by a full thickness skin graft may be needed to aid the healing process and ensure sufficient flexible skin coverage. The significant benefit of a skin graft is the much reduced recurrence rate associated with this procedure.
Minimally Invasive Techniques
In some cases, less invasive procedures may help release the thick cords without requiring a full incision, which may result in a quicker recovery. Percutaneous needle fasciotomy is in this category, as was the use of collagenase enzyme injections. The latter is currently not available in the UK.
Each surgical treatment aims to remove or release the dupuytren’s disease cords in the finger, allowing the finger to be straightened. Sometimes in severe cases, the joints themselves require release, thus allowing voluntary straightening. Mr Goon assesses each case individually, providing a tailored approach based on the extent of the contracture and the patient’s needs.
Dupuytren’s contracture surgery aims to alleviate the restrictions caused by thickened tissue, helping individuals regain hand functionality.
Benefits of Surgical Treatment for Dupuytren’s Contracture
Dupuytren’s contracture surgery offers several key benefits for patients with moderate to severe symptoms, helping restore hand function and prevent further progression of the condition.
- Relief from a Fixed Bent Position: Surgical treatments allow affected fingers with contractures to be extended or straightened, enhancing hand usability.
- Improved Functionality: Restores the ability to perform daily tasks with ease.
- Long-Lasting Symptom Relief: By addressing the thickened tissue, the risk of recurrence is minimised.
- Prevention of Further Progression: Surgery can prevent the condition from worsening and affecting the fingers permanently.
- Enhanced Outcome with Skin Grafts: In some cases, skin grafts will be recommended, ensuring a stable and functional recovery, and minimising recurrence.
Recovery and Aftercare
After surgery for Dupuytren’s contracture, patients typically require a brief period of rest to promote healing. Recovery plans may vary based on the type of procedure performed, but effective aftercare is essential to achieve the best outcome.
- Wrist and Hand Support: A splint may be recommended initially to stabilise the hand and reduce strain.
- Hand Therapy and Exercises: Targeted exercises help restore strength and flexibility in the affected finger joints, preventing stiffness. Splints will be recommended for nighttime use, for several months.
- Follow-Up Appointments: Regular check-ups will monitor progress and address any healing concerns.
- Gradual Return to Activities: Most patients can resume light daily activities relatively soon, though full recovery may take several weeks, depending on the extent of the Dupuytren contracture treated. Sutures are normally removed at the 2 week mark.
Why Choose UK Hand & Wrist Surgery
for Dupuytren’s Contracture Treatment?
UK Hand & Wrist Surgery provides expert care for Dupuytren’s contracture, with Mr Patrick Goon offering surgical techniques tailored to each patient’s needs. With experience in both traditional and minimally invasive approaches, Mr Goon specialises in hand surgery including microsurgery, and patients can be comfortable with the knowledge that he is well versed in surgery involving the delicate structures like the tiny nerves and blood vessels in the fingers, and able to deal with any scenario. He is dedicated to helping patients restore hand function and improve their quality of life.
Whether you’re experiencing early symptoms or have more severe symptoms requiring surgical intervention, UK Hand & Wrist Surgery is here to support your recovery and long-term hand health.
Meet Mr Patrick Goon
Mr Goon, a highly trained Specialist Hand Surgeon, leads our clinic with expertise and a commitment to excellence in care. His experience spans a range of simple to complex procedures, from carpal tunnel release to wrist joint replacements and tendon repair. His focus on minimally invasive techniques supports optimal recovery and reduces post-operative discomfort, ensuring patients achieve the best possible outcomes.
Find out more
Book an Appointment with Mr Goon
If you are suffering from a hand or wrist problem, please use the online form to contact us and arrange an appointment with Mr Goon. Alternatively, you can call us on 01707 443 444 or email us at Enquiries@hertfordshirehandsurgery.com
Frequently Asked Questions
How is Dupuytren’s contracture diagnosed?
Dupuytren contracture is typically diagnosed through a physical examination, where a specialist checks for signs of tissue thickening in the palm and limited finger movement. In some cases, further tests may be used to evaluate the severity and location of the contracture.
Can Dupuytren's contracture cause someone to develop severely bent fingers?
Yes, Dupuytren’s contracture can cause individuals to develop severely bent or contracted fingers over time. This happens as the thickened cords in the palm gradually pull the fingers into a bent position, restricting movement and impacting hand function.
What causes the tissue to form in Dupuytren's disease?
The tissue formation seen in Dupuytren’s disease is due to the development of dense abnormal connective tissue under the skin of the palm and fingers, which forms hard nodules and fibrous cords that contribute to finger contractures.
Are nodules and cords common in Dupuytren’s contracture?
Yes, nodules and cords are key characteristics of Dupuytren’s contracture. Nodules often form first, followed by cords that extend toward the fingers, gradually leading to contractures and restricted movement. Initially, the nodules and cords may be painful.
What Our Patients Say
Written by a NHS patient at Lister Hospital
5th July 2024
I managed to dislocate one knuckle and badly break another knuckle in the same finger into multiple pieces, an injury which every Healthcare Professional that saw the X-ray told me was not only severe damage but also a particularly rare injury. Mr Goon and his team screwed the knuckle back together, which was particularly fiddly given the multiple small pieces.
After the operation I was given a number of exercises which were progressively added to over a series of regular appointments, both with Mr Goon and multiple Hand Therapists, to check and monitor my progress. I followed their instructions as closely as I could, both in frequency of exercising and how far to push the injury (I did want to actually recover fully after all, so why would I have not listened to the experts!), even though this was sometimes inconvenient or sore.
I’m delighted to say that I now have full use and movement of the finger and a scar which is unnoticeable unless you look very closely for it. Mr Goon and his team are all a credit to the NHS, not only due to their expertise, but all kept a very friendly and positive attitude at all times not just about the potential recovery but also with their general demeanor, were always supportive and happy to answer any question I had, even if I was worried they may have been obvious answers, and were always clear about the next steps I needed to take.
It’s also worth mentioning for anyone that may be critical of the NHS which is clearly currently under intense pressure based on the number of patients in the Hospital ever time I went in, I sustained the injury on a Wednesday evening, had the dislocation sorted at a Hospital walk-in clinic within 1.5 hours and had met the surgeon, gone through the options and procedure and was in surgery by Saturday morning. Mr Goon even came to see me himself and tell me how the procedure had gone as soon as I was fully awake. This shows what an amazing service the NHS actually provides, and I didn’t have to pay a penny.
The whole experience has far exceeded my expectations and I can only thank Mr Goon and his entire team for the amazing work that they have done to ensure my full recovery.
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Written by a NHS patient at Lister Hospital
3rd October 2024
I had an accident at work that led to part of my finger being cut off. Mr. Goon has been treating me, and thanks to his skill, I’ve actually got that part of my finger back, including the nail. Honestly didn’t think that’d be possible, especially not so soon. I’m really grateful to have had such a great doctor during such a rough time. It couldn’t have gone better. Joe Efford
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Written by a NHS patient at Lister Hospital
10th October 2024
I saw Dr Goon following an accident with a horse which resulted in numerous breakages in my thumb. Having had numerous visits and having experienced terrible pain I was not sure if Doctor Goon could help. How wrong I was, he was extremely good in every aspect of his work getting my pain under control pretty quickly. He reassured me, listening to my concerns and always made me feel completely at ease. He has a very positive attitude at all times with every visit exceeding my expectations. I will require further surgery but I am not concerned as I cannot fault the care from Mr Goon and his great team to date. I know I will be in safe hands. He is indeed “The Miracle Man”.
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