Materiały źródłowe

• #1 Dupuytren Contracture: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16941-dupuytrens-contracture

  Dupuytren contracture can affect anyone. […] You might need surgery, but many cases can be managed with more conservative treatments. […] Conservative treatments for Dupuytren contracture include: Physical therapy or stretching exercises. Bracing or splinting to stretch your fingers to their usual range of motion (how far you can move them). Ultrasonic (painless sound waves) or heat treatments to increase your fascias flexibility. Corticosteroid injections to shrink nodules and cords. […] Your provider may refer you to a radiation specialist to help treat Dupuytren contracture or prevent your symptoms from progressing. Radiation therapy is a painless procedure that involves using X-rays or other beams aimed at the nodules or cords to soften them. […] If your symptoms havent improved after a few months of conservative treatments, your provider might recommend needle aponeurotomy.

• #1 Dupuytren contracture – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dupuytrens-contracture/diagnosis-treatment/drc-20371949

  In most cases, Dupuytren contracture can be diagnosed by the look and feel of the hands. […] If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you might not need treatment. Instead, you can wait to see if Dupuytren contracture progresses. You may wish to follow the progression with a tabletop test, which you can do on your own. […] Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways. The choice of procedure depends on the severity of your symptoms and other health problems you may have. […] This technique uses a needle, inserted through numbed skin, to puncture and break the cord of tissue that’s contracting a finger. Contractures often recur but the procedure can be repeated.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9996772/

  Current treatments for Dupuytrens disease are limited to late-stage disease when patients have developed flexion contractures and have impaired hand function. […] The use of treatments for early-stage disease, such as intralesional steroid injections or radiotherapy which lack a clear biological basis or evidence of effectiveness based robust randomized, double blind, placebo-controlled trials, highlights the desire of patients to access treatments before they develop significant flexion contractures. […] A systematic review of non-surgical treatments for early-stage Dupuytrens disease identified various pharmacological treatments (oral, intramuscular, topical or intralesional steroids; vitamin E, furazolidone, aminosyn (an amino acid solution), hyperbaric oxygen), radiotherapy and physical therapies (ultrasound, splinting, frictional massage or heat treatment with joint stretching).

• #1 Treatment Options for Dupuytren’s Disease: Tips and Tricks

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8849405/

  This article gives an overview of different treatment options for DD and each of their strengths and weaknesses and provides procedural tips. […] Percutaneous needle fasciotomy has an immediate improvement but a higher recurrence rate and rare tendon, or nerve complications. Collagenase injections require two visits and have an increased number of minor side effects, with rare tendon injuries. Limited fasciectomy removes the diseased tissue and has a prolonged recovery with a higher complication rate, but has the lowest recurrence rate. […] The mainstay of treatment remains limited fasciectomy (LF) surgery. Other treatments include percutaneous needle fasciotomy (PNF), open fasciotomy (OF), Clostridium collagenase histolyticum (CCH) injections, and dermofasciectomy (DF). […] Physical therapy treatments have had some success in treating established DD contractures. Hand therapy and orthotics are commonly prescribed after corrective DD treatment, but there is a lack of solid evidence to support this intervention.

• #1 Dupuytren contracture – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dupuytrens-contracture/diagnosis-treatment/drc-20371949

  In the early stages of the disease, steroid injections into the hard lump may help soften and flatten it. These injections also may help relieve pain from the nodules. […] Injecting a special enzyme, called collagenase, into the hard lumps and cords can soften and weaken them. At a second appointment within the following week, your hand is moved in a way to break up the cords and straighten your finger. This can reduce or even eliminate the contracture for several years. […] People with severe symptoms may need surgery to remove the tissue that’s bending the fingers. Surgery usually results in a more complete and longer lasting release than that provided by the needle or enzyme methods. But recovery takes longer. […] Any treatment of Dupuytren contracture may provide only temporary relief. The contraction of the fingers often returns with time.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9996772/

  The rationale for intranodular and intralesional steroid injections was based on early clinical and experimental studies examining the inhibitory effect on connective tissue development. […] Radiotherapy is usually directed against cells that are cycling. […] A randomized, double-blind placebo controlled trial of collagenase for early-stage Dupuytrens disease was not included in the systematic review of early-stage treatments, as collagenase is not approved for early-stage disease. […] A recent publication reported the results of a blinded randomized trial of ESWT with placebo in participants with painful Dupuytrens nodules followed for a total of 18 months. […] Taken together, the in vitro and phase 2a trial data show that anti-TNF downregulates the phenotype of myofibroblasts from Dupuytrens nodules.

• #1 Dupuytren’s Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0701/p86.html

  Referral to a hand surgeon is indicated if the MCP joint contracture reaches 30 degrees or if PIP joint contracture occurs at any degree. […] Timing of surgical intervention varies, but surgery is usually performed when the MCP joint contracture exceeds 40 degrees or when the PIP joint contracture exceeds 20 degrees. […] Surgery is usually successful, but recurrence is common. […] Percutaneous needle aponeurotomy of the nodule is an alternative to surgery. […] A study showed that injections with tri-amcinolone acetonide (Kenalog) monthly for up to five months, or every six weeks for up to three injections, followed by a six-month respite, lead to significant disease regression. […] Surgery was needed in fewer patients who received injections than would be anticipated in patients receiving expectant management alone.

• #1 Dupuytren Contracture

  https://www.massgeneral.org/condition/dupuytrens-contracture

  Steroid shot (injection). If a lump is painful, a steroid injection may help ease the pain. In some cases, it may stop your condition from getting worse. You may need repeated injections. […] Radiation therapy. This treatment is not as common in the U.S. Low energy X-rays are directed at the nodules. This works best in the early stage of the disease. It can soften the nodules and help keep contractures from happening. […] Enzyme injection. This is a newer, less invasive procedure done by specially trained surgeons. At the first visit your healthcare provider injects an enzyme medicine into the lump of tissue. Over several hours, the enzyme breaks down and dissolves the tough bands. At a second visit, usually 1 to 2 days later, the healthcare provider will inject the hand with numbing medicine. Then they will slowly stretch and straighten the finger joints until the cord is broken.

• #1 Dupuytren Contracture Treatment & Management: Approach Considerations, Rehabilitation, Collagenase Injection

  https://emedicine.medscape.com/article/329414-treatment

  Recurrrence of disease is problematic across all treatment options. […] CCH and PNF have higher recurrence rates than fasciectomy, but the recurrence rate after 5 years with limited fasciectomy was 20.9%. […] A study by Leafblad et al that compared outcomes and costs of three Dupuytren contracture treatments concluded the following: CCH treatment resulted in the highest rate of reintervention at 2 years, comparable reintervention rates to PNF at 5 years, and the highest cumulative costs. […] PNF was the least expensive intervention and resulted in longer duration before reintervention compared with CCH. […] There is no general agreement on treatment recommendations regarding the choice between PNF, surgery, and CCH at this time among hand surgeons. […] Intralesional triamcinolone acetonide (Kenalog-40) injections of 40 mg/mL have yielded subjective improvement in the size of Dupuytren nodules in some patients. […] However, corticosteroid injections are associated with a high risk of complications, including fat atrophy and skin discoloration.

• #1 Best 5 Exercises for Dupuytren’s Contracture – Surrey Physio

  https://www.surreyphysio.co.uk/top-5/best-5-exercises-for-dupuytrens-contracture/

  Best 5 Exercises for Dupuytrens Contracture […] How is Dupuytren’s Contracture Treated? […] In most cases, patients are just told to manage it or accept it. However, we firmly believe that physiotherapy can help. First, exercises can be used to stretch the fingers and massage to the palm may help too. […] Also, shockwave could be useful, and we provide this at Surrey Physio for 65.00 per session (current price correct at time of writing the article, but check the price page for up-to-date pricing). Shockwave is a non-invasive treatment that uses sound waves to stimulate healing in affected areas. Several studies have investigated the effectiveness of shockwave in treating Dupuytren’s contracture. One study found that shockwave reduced contracture and improved range of motion and quality of life for patients with Dupuytren’s Disease palmar nodules. Other studies have shown that shockwave is able to reduce Dupuytren’s contracture and improve function. Shockwave therapy proves to be a promising effective non-invasive therapy in the reduction of Dupuytrens contracture. […] Overall, while more research needs to be done, shockwave is a promising option for treating Dupuytren’s contracture that we use at Surrey Physio and its well worth trying. […] If you have severe cases of Dupuytren’s contracture that don’t respond to conservative treatment, your doctor may recommend surgery as well as other options such as wearing splints or braces on your hands at night to keep them straightened out while you sleep. Surgery has been shown to improve hand function in some patients who undergo this procedure; however, it does come with some risks including infection and scarring around the incision site (which may require additional treatment). […] The most common surgical treatment is called palmar fasciectomy, which involves removing the affected tissue from your palm. This procedure can be done in an outpatient setting and usually takes less than an hour to complete. There are mixed results with them. According to the NHS, the surgery is not recommended as DC tends to come back so results can be short term. However, some patients do report better results than research would suggest.

• #1 Treatment Options for Dupuytren’s Disease: Tips and Tricks

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8849405/

  Low-dose radiotherapy may halt disease progression via inhibition of myofibroblasts. However, a systematic review of its use showed that the proof of its clinical efficacy is scarce. […] Steroid injection can cause regression of nodules and cords found in early DD. […] Results from the ongoing phase 2 randomized controlled trial in England showed injecting adalimumab, an anti-TNF agent, directly into DDs nodules effectively inhibits the myofibroblasts in a dose-dependent fashion compared with saline control at 2-week follow-up. […] CCH injection has a favorable safety profile with rare severe complications, and it especially works well on MCPJ contractures or lower severity disease. […] PNF can be performed under local anesthesia in an office and can be repeated multiple times. Although PNF has a high recurrence rate, it has many advantages, including immediate result, fast recovery, low cost, and that it does not preclude any future interventions such a fasciectomy.

• #1 Radiation Offers Hope for Patients With Dupuytren’s Contracture

  https://www.baystatehealth.org/patient-stories/radiation/elizabeth-carr

  The best results occur when the treatment is performed early in the course of the disease both in terms of length of time present and the amount of deformity. With early treatment, up to 85% of patients treated have stability or reduction in the cords or nodules. […] At Baystate, we believe in offering radiation for patients with Dupuytrens contracture after they have evaluated all available options. […] Recommendations for other common treatments for Dupuytrens contracture vary due to the severity of the disease and include steroid shots, enzyme injections, and needle aponeurotomy. Surgery is often used in more advanced cases where patients have limited mobility of their hand, the problem is that eventually the scar tissue and contractures may recur resulting in even more limited mobility. Radiation can be used after surgery, but it is less successful. […] I would highly recommend considering this procedure for those with Dupuytrens contracture. It was one of the easiest procedures that I have undergone with little discomfort. And, the best part of all was that I was able to continue with all my activities, said Carr.

• #1 Dupuytren Contracture Treatment & Management: Approach Considerations, Rehabilitation, Collagenase Injection

  https://emedicine.medscape.com/article/329414-treatment

  Radiotherapy can be effective in slowing disease progression in the early stages of Dupuytren contracture, and may even provide long-term relief of symptoms. […] However, the authors concluded that on balance, radiotherapy should be considered an unproven treatment for early Dupuytren contracture, in view of the limited evidence base and unknown long-term adverse effects. […] Percutaneous needle fasciotomy (PNF), or needle aponeurotomy, is a minimally invasive treatment that is usually performed as an office procedure under local anesthesia. […] PNF may be an effective initial intervention in the treatment of Dupuytren contracture, either alone or as a first step to subsequent procedures such as repeated fasciotomy, fasciectomy, or CCH injection. […] An open fasciotomy is sometimes used to manage more severe cases of Dupuytren contracture, and is more effective in the long term when compared with needle aponeurotomy. […] Open fasciotomy is usually reserved for patients who cannot tolerate a more extensive procedure.

• #1 Recover Faster with Minimally Invasive Treatment for Dupuytren’s

  https://www.orthocarolina.com/media/minimally-invasive-treatment-yields-quick-recovery-for-dupuytrens-disease

  Dupuytren’s contracture is a benign condition which causes a tightening of the flesh beneath the skin of the palm and can result in permanently bent fingers. […] Traditional treatment for Dupuytren’s disease involves fasciectomy or surgical excision of the diseased cords and nodules. […] An alternative to open surgery, Needle Aponeurotomy (NA) is a minimally invasive treatment for Dupuytren’s contracture. […] In contrast to surgical treatment, Needle Aponeurotomy allows a more rapid recovery. […] The NA procedure is performed as an outpatient under local anesthesia. […] The advantages of Needle Aponeurotomy are obvious, most notably the quicker recovery of two to seven days as opposed to two to three months for traditional surgery. […] For those patients who have a contracture of the hand that is confirmed to be Dupuytren’s disease and for whom the contracture is impairing normal function and use of the hand, Needle Aponeurotomy offers a minimally invasive treatment with a quick recovery time and rapid return to normal activities.

• #1 Minimally Invasive Dupuytren’s Contracture Treatment

  https://www.orlandoortho.com/minimally-invasive-dupuytrens-contracture-treatment/

  Minimally Invasive Dupuytrens Contracture TreatmentHand surgeons across the United States can see several patients per month with the disorder known as Dupuytrens contracture a progressive, abnormal thickening of the tissue of the palm of the hand that actually can pull the finger permanently toward the palm. […] Until recently, patients had to undergo an invasive surgery to correct the abnormality. Surgeons would have had to operate near nerves in the hand to provide relief. The next evolution of treatment came in the form of Needle Aponeurotomy, a less invasive procedure to provide relief. […] A different technique that doesnt require any cutting is now available to treat Dupuytrens contracture. It is available from the hand specialists at Orlando Orthopaedic Center. […] The breakthrough method to treat Dupuytrens contracture involves the use of the only FDA-approved, nonsurgical treatment for adults with the disorder known as Xiaflex. The process involves an enzyme injection and minimal patient discomfort.

• #1 Dupuytren’s Disease / Dupuytren’s Contracture | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/hand-program/dupuytrens-contracture

  In select cases, the contracted, diseased tissue can be weakened by simply puncturing it with a needle multiple times through the skin. This procedure can be performed under local anesthesia and give quick results, much like Xiaflex injection. However, the rate of recurrence after this procedure appears to be higher than other treatments.

• #1 Dupuytren contracture

  https://dermnetnz.org/topics/dupuytren-contracture

  Limited fasciectomy is indicated for patients with loss of function of the affected hand due to progressive contracture. An isolated lesion with a single cord or band responds better to surgery than diffuse forms of the disease and can be operated on more aggressively. […] Percutaneous needle fasciotomy is less invasive than fasciectomy and has a fast recovery and low complication rates, but the recurrence rate is up to 65% within 3-4 years. […] The risks associated with a surgical procedure for Dupuytren contracture include damage to the nerves and flexor tendons and the formation of pseudo-aneurysms (pockets of blood in the bloodstream).

• #1 Treatment Options for Dupuytren’s Disease: Tips and Tricks

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8849405/

  Management of DD includes observation, non-operative management, and operative management. Operative treatments include percutaneous needle fasciotomy (PNF), open fasciotomy (OF), Clostridium collagenase histolyticum (CCH) injections, limited fasciectomy (LF) and dermofasciectomy (DF). […] PNF has an immediate improvement, but a higher recurrence rate, potential problematic skin tears, and rare tendon or nerve complications. Limited fasciectomy removes the thickened, diseased tissue but has a more prolonged recovery and has a higher rate of significant complications. Dermofasciectomy has the highest complication rate, and the lowest recurrence. […] Collagenase injections require two visits, have an increased number of minor side effects such as skin tears, and have rare but significant side effects such as tendon rupture.

• #1 About XIAFLEX® for Dupuytren’s Contracture

  https://dupuytrens-contracture.xiaflex.com/patient/about-xiaflex/

  XIAFLEX is an FDA-approved nonsurgical injectable treatment for adults with Dupuytrens contracture when a cord can be felt. XIAFLEX should be injected by a healthcare provider experienced in injection procedures of the hand and in treating people with Dupuytrens contracture. […] XIAFLEX is injected into the collagen cord that is causing the contracture. After injection, the XIAFLEX enzymes are thought to attach to the collagen that makes up the rope-like cord in the palm, unwinding the collagen and eventually breaking it down. […] XIAFLEX is an injection given in a doctors office by a Hand Specialist trained in XIAFLEX. Treatment doesnt require general anesthesia, and up to 2 cords in 1 hand may be treated during 1 office visit. […] Studies show that prescription XIAFLEX, along with a finger extension procedure, may help straighten or nearly straighten finger(s) affected by Dupuytrens contracture and may improve range of motion after up to 3 injections.

• #1 Non-Surgical Dupuytren’s Contracture Treatment | Hand Center

  https://handsurgical.com/announcing-nonsurgical-procedure-dupuytrens-contracture/

  Nonsurgical treatment options for Dupuytren’s contracture include XIAFLEX®, an enzyme injection that restores finger motion by treating the cord in the patient’s hand. […] Most treatment techniques target the cords that pull your fingers toward the palm. Explore these nonsurgical treatment options for Dupuytren’s contracture: […] XIAFLEX® is the only FDA-approved treatment for Dupuytren’s contracture that doesn’t require surgery. […] After the injection, your doctor wraps your hand with bandages and gives you specific instructions for at-home care. […] The use of a splint and finger exercises may be recommended for several months to improve and maintain function.

• #1 Dupuytren’s Disease / Dupuytren’s Contracture | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/hand-program/dupuytrens-contracture

  The University of Michigan is also using a new FDA-approved treatment for Dupuytren’s disease: clostridial collagenase (XIAFLEX) injections that destroy the excess collagen causing the thickening and shortening of the tissue. In some cases, only one injection is needed to dramatically improve the function of the hand. More complex cases may require a series of two or three injections for full treatment. […] Treatment with Xiaflex is a two-step process. At the first visit, the medication is injected into the selected Dupuytrens cord. The next day, a stretching procedure is used to break up the weakened cord and extend the finger. Both of these steps are performed with local anesthesia for comfort. […] Recovery time and need for physical therapy are dramatically reduced with injections compared to traditional surgical treatment. The early results of this treatment indicate that it is nearly as effective as surgery, but long-term recurrence rates have not yet been determined.

• #1 About XIAFLEX® for Dupuytren’s Contracture

  https://dupuytrens-contracture.xiaflex.com/patient/about-xiaflex/

  XIAFLEX has a well-established safety profile for the treatment of Dupuytrens contracture in adults over 18 with a cord that can be felt. […] The most common side effects with XIAFLEX for the treatment of Dupuytrens contracture include swelling of the injection site or the hand; bruising or bleeding at the injection site; pain or tenderness of the injection site or the hand; swelling of the lymph nodes (glands) in the elbow or armpit; itching; breaks in the skin; redness or warmth of the skin; and pain in the armpit. […] XIAFLEX is only available by prescription. Visit a Hand Specialist trained in XIAFLEX and ask about XIAFLEX for your Dupuytrens contracture.

• #1 Dupuytren’s Disease – Dupuytren’s Contracture – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/

  An injectable medication has been developed to take advantage of these differences. […] While this is a good non-operative alternative to surgery, it should be noted that recurrence (return) of the disease is higher with this treatment than with surgery. […] If the contracture interferes with hand function, your doctor may recommend surgical treatment. […] The goal of surgery is to reduce the contracture and improve motion in the affected fingers. […] The surgical procedures most commonly performed for Dupuytren’s contracture are: Fasciotomy, Partial palmar fasciectomy. […] In this procedure, your doctor will make an incision in your palm, then divide the thickened cord(s) of tissue. […] Partial palmar fasciectomy is a more extensive (bigger) procedure than fasciotomy. […] As with any surgery, there are risks associated with surgery for Dupuytren’s contracture. […] Physical therapy can help improve strength and function in your fingers and hand, reduce swelling, and aid in wound care. […] In general, treatment of Dupuytren’s disease can be quite successful.

• #1 Dupuytren’s contracture

  https://www.nhs.uk/conditions/dupuytrens-contracture/

  A cut is made along your palm and finger so the surgeon can straighten it. […] Recovery time: 4 to 12 weeks. […] Lowest risk of contracture coming back. […] A needle is inserted into several places along your palm and finger to loosen and straighten it. […] Recovery time: up to 2 weeks. […] Contracture more likely to come back than with surgery. […] Similar to a fasciectomy, except an additional area of skin is removed; a skin graft from elsewhere in the body is used to replace the removed skin. […] Contractures less likely to come back than with a standard fasciectomy but recovery times can be longer.

• #1 Treatment Options for Dupuytren’s Disease: Tips and Tricks

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8849405/

  All affected DD and nodules are removed while the neurovascular bundle is traced out and protected in LF. The recovery is prolonged, and swelling during immobilization can lead to stiffness with flexion. On the other hand, it has a much lower recurrence rate than fasciotomy or CCH injections. […] DF involves removing the affected DD and skin and coverage with a full-thickness skin graft. It has the lowest recurrence rate. […] The most common cause of elective amputation of the digits is from DD, and it may be recommended in severe, recurrent cases. […] All current treatments may result in devastating complications for the patient. […] A randomized controlled trial with 166 rays treated with either LF or PNF showed that total passive extension deficit was significantly better with LF than PNF.

• #1 Dupuytren Contracture Treatment & Management: Approach Considerations, Rehabilitation, Collagenase Injection

  https://emedicine.medscape.com/article/329414-treatment

  This involves excising only the fascia that is grossly affected (eg. in the palm, pretendinous cords and involved natatory ligaments; in the fingers, only those structures that are visibly affected). […] Although the disease process clearly extends into clinically normal palmar fascia, this approach has proven successful in correcting MCP joint contractures and some PIP contractures and carries an acceptably low morbidity rate. […] This removes the diseased fascia and the overlying skin. […] The wound is then resurfaced and a full thickness skin graft is applied. […] A fasciotomy or regional fasciectomy is usually sufficient to establish normal function in the MCP joint. […] The procedure of choice for PIP joint involvement is either dermofasciectomy or extensive fasciectomy. […] Routine postoperative care is essential for an optimal outcome. […] The overall goal of splinting is to provide a prolonged stretch to the tissues and prevent flexion contractures.

• #1 Dupuytren’s Disease Treatment – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/orthopaedic-surgery/hand-and-upper-extremity/dupuytrens-disease

  If diagnosed early, symptoms of Dupuytren’s disease may be reduced without surgery. Non-surgical treatments include: […] Enzyme injection, a minimally invasive procedure done in an office visit and involving the injection of an enzyme solution into the cords in your hand. Over several hours to days, the enzyme breaks down and dissolves the contracted tissue. Your surgeon will snap the cords by manipulating and straightening your fingers. […] Needle aponeurotomy involves passing the sharp end of a hypodermic needle back and forth through the restrictive cords to weaken and divide the diseased tissue. […] If non-surgical treatment does not relieve your symptoms, surgery may be recommended. Surgical approaches include: […] Fasciotomy involves making an incision in your palm through which your surgeon divides the thickened tissue. Dividing the cord helps to decrease the contracture and increase finger movement. […] Subtotal palmar fasciectomy involves a zig-zag incision along the creases in the hand through which all the abnormal tissue and cord is removed to straighten your fingers. On occasion a skin graft may be needed to help the wound heal.

• #1 Physical therapy in California South Bay for Dupuytrens Contracture Surgery

  https://www.davisandderosa.com/Injuries-Conditions/Hand/Surgery/Dupuytrens-Contracture-Surgery-Patient-Guide/a~4515/article.html

  Dupuytren’s contracture is a fairly common disorder of the fingers. Both non-surgical and surgical treatment options are available for Dupuytren’s contracture, but this guide will focus on the surgical option. For more information on the non-surgical options, refer to A Patient’s Guide to Dupuytren’s Contracture. In regards to surgical procedures a partial palmar fasciectomy remains the “gold standard” procedure, although at earlier stages of this disease a less invasive surgical procedure called a needle aponeurectomy may be done. It should be noted that surgical treatment does not always stop or cure this disease process, so recurrence can occur. […] Many cases of Dupuytren’s contracture progress to the point where surgery is needed. The goal of surgery is to remove the diseased fascia, allowing the finger to straighten out again. By removing the tight cords and fascia, the tension on the finger is released. Once the fibrous tissue is removed, the skin is sewn back together with fine stitches.

• #1 Dupuytren Contracture Treatment & Management: Approach Considerations, Rehabilitation, Collagenase Injection

  https://emedicine.medscape.com/article/329414-treatment

  Surgical interventions consist mostly of fasciectomy. […] Complete extension of affected joints may be possible with earlier intervention. […] In a study that compared CCH injection with limited fasciectomy in 132 patients with Dupuytren contracture, Zhou and colleagues reported no significant difference in the degree of residual contracture of the MCP joint (13 with CCH versus 6 with surgery; P = 0.095). […] However, patients treated with CCH had more rapid recovery of hand function and experienced fewer serious adverse events than did those treated with fasciectomy. […] A meta-analysis by Sanjuan-Cervero et al looked at the safety and efficacy of CCH compared with fasciectomy and percutaneous needle fasciotomy (PNF) in Dupuytren disease. […] This study found that short- and medium-term improvement to joint movement achieved with CCH were similar to those achieved with fasciectomy, although fasciectomy did outperform CCH with regard to treatment of PIP joint contractures.

• #1 Physical therapy in our clinic for Hand – Dupuytrens Contracture

  https://www.rmts.clinic/article.php?aid=4516

  Surgery is usually recommended when the joint at the knuckle of the finger reaches 30 degrees of flexion. […] The goal of tissue release surgery is to release the fibrous attachments between the palmar fascia and the tissues around it, thereby releasing the contracture. […] This remains the gold standard of treatment for Dupuytren’s contracture. Removal of the diseased palmar fascia will usually give a very good result. […] A less invasive procedure called a needle aponeurotomy (also referred to as a percutaneous fasciotomy) is available when the disease is at an early stage. […] A skin graft may be needed if the skin surface has contracted so much that the finger cannot relax as it should and the palm cannot be stretched out flat.

• #1 Dupuytren’s Disease / Dupuytren’s Contracture | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/hand-program/dupuytrens-contracture

  The University of Michigan hand surgery team is not only experienced in traditional methods of treatment, but also offers a revolutionary new treatment approved by the FDA for those affected by Dupuytren’s disease. […] For a long time, treatment for Dupuytren’s Disease was limited to surgery. In recent years, however, new treatments have become available. Our specialized hand surgeons work with patients to identify the best course for their particular health and lifestyle. […] In mild cases, we recommend monitoring the thickened tissue for progression. If the disease progresses enough to cause problems with daily hand use, there are various treatment options. We recommend discussing these options with your hand surgeon. […] A procedure that removes the diseased tissue is called fasciectomy. This procedure is usually a very effective method of treatment. However, the recovery time can be long, especially if the skin is in bad condition and skin grafts are needed. Skin grafting requires months of recovery, and physical therapy may be necessary. Recurrence of the disease after this surgery is about 20%.

• #1 Dupuytren’s contracture – Wikipedia

  https://en.wikipedia.org/wiki/Dupuytren%27s_contracture

  Clostridial collagenase injections have been found to be more effective than placebo. […] The treatment with collagenase is different for the MCP joint and the PIP joint. […] Radiation therapy has been used mostly for early-stage disease, but is unproven. […] Postoperative care involves hand therapy and splinting. […] Besides hand therapy, many surgeons advise the use of static or dynamic splints after surgery to maintain finger mobility. […] A third approach emphasizes early self-exercise and stretching. […] Dupuytren’s disease has a high recurrence rate, especially when a person has so-called Dupuytren’s diathesis.

• #1 Physical Therapy Exercises Following Dupuytren’s Contracture Release Surgery: Consistency Is Key – Minnesota Valley Surgery Center

  https://minnesotavalleysurgerycenter.com/hand-surgery/physical-therapy-exercises-following-dupuytrens-contracture-release-surgery-consistency-is-key/

  Dupuytrens contracture release surgery is the surgical treatment for the hand disease Dupuytrens contracture. The condition causes the fascia to thicken and tighten, permanently pulling the fingers inward. During the release surgery, the surgeon removes the thickened tissue to free up the skin and joints, thereby increasing finger mobility. However, the release surgery alone is not enough to permanently treat the disease. The patient still needs several physical therapy sessions to increase finger motion, strength, and function. […] The patient will then start physical therapy with a qualified therapist, often surgeon-referred. The therapist will teach the patient safe ways to massage the hand and fingers to lessen the swelling. Specific exercises will also help achieve optimal recovery.

• #1 Dupuytren’s Contracture: Treatment for hand contractures

  https://handtherapy.co.za/hand/dupuytrens-contracture/

  Strength training: The tendon will need gradual loading exercises to recondition the tendon. […] Sensory retraining To restore the normal feeling in your fingers, the the nerve is affected. […] Oedema management Reduce swelling in and around the hand and fingers. […] 1st Phase: Prevent the Contrature getting worse. […] 2nd Phase: Use of Splinting, loading exercises to regain the normal open hand position. […] 3rd Phase: Regain normal Finger Range of movement. […] 4th Phase: Grip Muscle Strength Regain normal grip. […] 5th Phase: Dexterity Fine motor skills Able to perform intricate delicate actions using the fingers hand. […] 6th Phase: Return to full function Participation Able to catch an incoming ball, reflex testing, reaction ball retraining. […] Without surgery we are able to restore it to normal function using our 12 week program.

• #1 Dupuytren’s Contracture Treatment Options | Dr. Haynes III

  https://www.osc-ortho.com/blog/procedural-and-surgical-treatment-of-dupuytrens-contracture/

  Post-Surgical Physical Therapy […] Once everything has healed sufficiently, post-procedural therapy will be crucial to regain and maintain hand flexibility and function. Exercises will be important to improve mobility and strength. Modalities like laser therapy can be very therapeutic for scar tissue and adhesions. Massage and manual therapy will also help to prevent the formation of more scar tissue and relax scarring over incision sites. […] Splinting may also be recommended to keep fingers extended during recovery.

• #1 Physical Therapy Exercises Following Dupuytren’s Contracture Release Surgery: Consistency Is Key – Minnesota Valley Surgery Center

  https://minnesotavalleysurgerycenter.com/hand-surgery/physical-therapy-exercises-following-dupuytrens-contracture-release-surgery-consistency-is-key/

  Even after regaining full use of the hand, patients still need gentle stretching and strengthening exercises for up to 6 months after the surgery. […] Tendon gliding exercises are among the most recommended activities to help with recovery. […] Stopping physical therapy means a more extended period of pain, less motion, and reduced grip strength. […] Undergoing release surgery for Dupuytrens contracture can help decrease stiffness and pain while improving flexibility. However, surgery alone cannot fully restore the hands strength, motion, and function. In addition, due to factors like age and health, some patients heal faster than others. Therefore, physical therapy exercises are equally important.

• #1 Dupuytren’s contracture – Wikipedia

  https://en.wikipedia.org/wiki/Dupuytren%27s_contracture

  Initial treatment is typically with cortisone injected into the affected area, occupational therapy, and physical therapy. […] Among those who worsen, clostridial collagenase injections or surgery may be tried. […] The main categories listed by the International Dupuytren Society in order of stage of disease are radiation therapy, needle aponeurotomy (NA), collagenase injection, and hand surgery. […] Hand surgery is effective at stage I to stage IV. […] Use of a splint to keep treated fingers straight following various forms of treatment, typically at all times for some days, then at nighttime for some weeks, is usual. […] Needle aponeurotomy is a minimally-invasive technique where the cords are weakened through the insertion and manipulation of a small needle. […] The advantage of needle aponeurotomy is the minimal intervention without incision (done in the office under local anesthesia) and the very rapid return to normal activities without need for rehabilitation, but the nodules may resume growing.

• #1 Treatment Options for Dupuytren’s Disease: Tips and Tricks

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8849405/

  PNF is similar to CCH in results. […] The senior author feels that patients fall into a simple algorithm ladder of treatment. PNF or CCH injections would be the initial treatment. […] Wide awake local anesthetic no tourniquet surgery for DD avoids the use of the arm tourniquet and a deeper level of anesthesia. […] CCH injections can be used as the primary treatment or for recurrences after PNF, OF, LF, or DF. […] Removal of thickened and diseased cords is the goal of LF. […] All current DD treatments have issues with recurrence, and there is no clear definition of recurrence. […] Those with DD need to know that there is hope with a variety of options available for treatment. The biggest trade-off in DD treatments is fast recovery with higher recurrence rates versus longer recovery with lower recurrence rates.

• #1 Dupuytren Contracture Treatment & Management: Approach Considerations, Rehabilitation, Collagenase Injection

  https://emedicine.medscape.com/article/329414-treatment

  A variety of non-surgical and surgical options are available for management of Dupuytren disease (DD). The choice largely depends on the severity of disease, degree of deformity, limitations in function, and provider preference. Although there is no consensus, it is generally accepted that surgical procedures are reserved for patients with contractures 30-40 or with significant disability. […] In advanced cases a variety of techniques may be used to prevent recurrence (eg, skin grafting, external fixator application, radiation). […] Observation is appropriate for patients with unchanging, painless Dupuytren disease who have minimal contracture and no functional impairment. […] Patients with mild Dupuytren disease can be monitored on an infrequent basis via a brief follow-up visit every 6-12 months.

• #1 Dupuytren’s Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0701/p86.html

  Dupuytren’s disease is a progressive condition that causes the fibrous tissue of the palmar fascia to shorten and thicken. […] The disease initially can be managed with observation and non-surgical therapy. […] Steroid injection into the nodule has been shown to reduce the need for surgery. […] Surgical referral should be made when metacarpophalangeal joint contracture reaches 30 degrees or when proximal interphalangeal joint contracture occurs at any degree. […] Timing of surgical intervention varies, but surgery is usually performed when the metacarpophalangeal joint contracture exceeds 40 degrees or when the proximal interphalangeal joint contracture exceeds 20 degrees. […] In-office percutaneous needle aponeurotomy is an alternative to surgery. […] Surgery is recommended if function is impaired, contracture is progressing, or severe deformity is disabling.

• #1

  https://www.orthobullets.com/hand/6058/dupuytrens-disease

  Dupuytren’s Disease is a benign proliferative disorder characterized by decreased hand function that begins as a painless nodule and can progress to form diseased cords and contractures of the palm and fingers. […] Treatment ranges from nonoperative through observation, collagenase injections, and needle aponeurotomy to operative open fasciectomy if the disease progresses or affects a patient’s daily living. […] Nonoperative treatment includes observation for nodules alone with no functional impairment, hand therapy for mild cases with minor contracture, corticosteroid injections for painful nodules, and collagenase clostridium histolyticum (CCH) injections for palpable cords. […] Operative treatment options include partial palmar fasciectomy for MCP and PIP flexion contractures, total/radical palmar fasciectomy for severe cases, and salvage techniques for chronically recurrent disease. […] Hand therapy may involve ultrasound and heat in early stages, as well as bracing or splinting to stretch digits. […] Collagenase injections selectively target collagen types I and III, and percutaneous needle aponeurotomy is performed in-office for mild contractures.

• #1 Dupuytren’s treatments | The British Dupuytren’s Society

  https://dupuytrens-society.org.uk/treatment-2/dupuytrens-disease/

  Needle Aponeurotomy – is a good option if any contracture is not too severe and if the cord is well away from tendons and nerves in the hand. […] Collagenase injection (Xiapex) – No longer routinely available in Europe, Asia or Australia anymore from the beginning of 2020. […] Surgery – there are different types and your surgeon will decide which is needed. Surgery is advised when the MCP joint (the one that connects the finger to the hand) is more than 40% bent, or the PIP joint (second finger joint from the tip) is more than 20% bent. […] Shockwave, steroid injections (especially for painful nodules), ultrasound…

• #1 Dupuytren’s Contracture of the Fingers | EmergeOrtho

  https://emergeortho.com/conditions/dupuytrens-contracture/

  Surgical release of the diseased tissue is a common treatment for Dupuytrens contracture. […] In this outpatient surgery, an incision is made in the hand and the surgeon cuts and removes the thick band of tissue to improve movement of the tendons. Physical therapy is needed after surgery and recovery could take several weeks. […] Two new treatments have developed in last 5-10 years. These include enzyme injections and needling to help passively extend the fingers. […] Enzyme is injected into cord in the palm to help soften and weaken the cord. The patient returns to the office the next day and physician is able to passively extend finger to make it straight. […] This is an in-office procedure that involves the use of needles moving in an up and down fashion, similar to a needle on a sewing machine, to help divide the cords. This allows the fingers to be extended straight and can help avoid surgery. […] It is important to note that the underlying condition still exists and contraction can reoccur.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9996772/

  The phase 2b clinical trial data suggest that intranodular injections of adalimumab may be efficacious in delaying or preventing the progression of early-stage Dupuytens disease although follow-up over approximately 10 years would be required to confirm this. […] There is a pressing need for safe, effective treatments for early-stage disease.

• #1 Breakthrough in treatment for Dupuytren’s disease | University of Oxford

  https://www.ox.ac.uk/news/2022-05-03-breakthrough-treatment-dupuytren-s-disease

  Injection of the anti-TNF drug adalimumab into Dupuytrens disease nodules is effective in reducing nodule hardness and nodule size. […] Researchers at the Kennedy Institute, University of Oxford, led by Professor Jagdeep Nanchahal have demonstrated the efficacy of the anti-TNF drug adalimumab for patients with early stage Dupuytrens disease. […] 'We also found the treatment to be completely safe and there were no related serious adverse events.’ […] The trial recruited 140 participants with early-stage Dupuytrens disease who were randomised to receive 4 injections at 3 monthly intervals of either adalimumab (40mg adalimumab in 0.4ml) or saline. […] Published in The Lancet Rheumatology, the study found that the patients receiving adalimumab experienced softening and reduction in size of the treated nodule.

• #1 Nonsurgical Treatment for Dupuytren’s Contracture

  https://www.drdipaolo.com/blog/nonsurgical-treatment-for-dupuytrens-contracture-43611.html

  Ultrasound therapy is another option that uses sound waves to penetrate deep into the tissues. It can break up fibrous cords and improve blood flow, which may alleviate some of the symptoms of Dupuytrens. While not a cure, ultrasound can provide temporary relief when combined with other therapies. […] For patients seeking a more effective nonsurgical option, XIAFLEX stands out as the only FDA-approved treatment when a palpable cord is present. XIAFLEX is an enzyme injection that breaks down the collagen in the cord, allowing the fingers to straighten. This minimally invasive procedure involves injecting the enzyme directly into the cord, followed by a gentle manipulation of the finger to improve movement. Patients often experience significant improvement in hand function with a shorter recovery time compared to surgery. Among the viable options for those looking to avoid surgery, XIAFLEX provides the most effective solution for advanced cases. If youre dealing with Dupuytrens contracture, schedule a consultation with Dr. DiPaolo to find out if you might benefit from XIAFLEX.

• #1 Dupuytren’s contracture | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dupuytrens-contracture

  Dupuytren’s contracture is a thickening and shortening of tissue in the palm, resulting in clawed fingers as they are pulled towards the hand. […] Treatment options include injections of corticosteroids into the palm and surgery. […] Treatment depends on the severity of the condition, but may include injections of corticosteroids into the palm and surgery. […] In its earlier stages, treatment may include injections of corticosteroids into the fascia. These medications reduce any localised tenderness and may help to delay subsequent thickening of the tissue. More recent treatments showing promise include therapy with calcium channel blockers, treatment with gamma-interferon and percutaneous needle fasciotomy. […] In severe or advanced cases, the person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional. Surgery is then the best option.

• #1 Mayo Clinic Minute: Treating Dupuytren contracture without surgery – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-treating-dupuytrens-contracture-without-surgery/

  Dupuytren contracture is a condition that causes one or more fingers to bend toward the palm of the hand. The affected fingers can’t straighten completely. It most often affects the two fingers farthest from the thumb. […] Patients with advanced disease will need an intervention to relieve the contracture. There are several treatment options. An enzyme injection is a newer, less invasive treatment. […] „It actually dissolves the thickened Palmer cords and fascia allowing the fingers to straighten,” she says. […] But if you’re unable to lay it flat because of the contractures in the fingers, then you would want to seek care with a hand surgeon specializing in Dupuytren’s disease.

• #1 Dupuytren’s Contracture Causes & Treatment | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/dupuytren-contracture

  Baptist Health is known for advanced, superior care for patients with orthopedic conditions and the diagnosis, treatment and management of Dupuytren’s contracture. […] The main treatments for Dupuytren’s contracture are: […] Nonsurgical treatment may help to slow the disease progression. Nonsurgical options include steroid and enzyme injections, needling (a technique where needle punctures are used to break up the fibrous cord of tissue under the skin) and splinting (which does not prevent increased beading in the finger). […] Surgery is an option for patients who can no longer perform everyday tasks such as putting on gloves or placing their hands in their pockets, and offers the best possibility of longer-term flexibility. Surgery divides or removes the thickened bands under the palm skin to help restore finger mobility. Skin grafting may be needed to heal the resulting wound.

• #1 Facts on Hand: Dupuytren’s Contracture

  https://www.factsonhand.com/

  Take charge of your Dupuytrens contracture treatment […] If you cant lay your hand flat against a table, you may have Dupuytrens contracture. […] They can tell you if you have Dupuytrens contracture and can inform you of your options, including nonsurgical treatment. […] There are both surgical and nonsurgical treatment options available. […] Dupuytrens contracture may be a lifelong condition. A contracture will not get straighter without treatment and may come back even if treated. […] You dont have to wait for Dupuytrens contracture to limit the use of your hand before looking into treatment. See a Hand Specialist as soon as you notice changes in your hand. […] Dupuytrens contracture is treatable without surgery. There are minimally invasive, in-office procedures available. […] If you think nonsurgical treatment is right for you but your Hand Specialist doesnt offer it, get a second opinion—there are Hand Specialists who will listen.

• #1 Home Remedies to Treat Dupuytren’s Disease | OrthoBethesda

  https://www.orthobethesda.com/blog/home-remedies-to-treat-dupuytrens-disease/

  Home remedies to treat dupuytrens disease. […] What is the best treatment for Dupuytrens contracture? […] Unfortunately, there is no cure for Dupuytrens contracture. Treatment focuses on minimizing the systems of the disease. […] How do you reverse Dupuytrens contracture? […] Stretching does help Dupuytrens contracture, and there a number of exercises you can do to help manage this condition. […] Massage is a good follow-up to exercise, but it can be beneficial as a standalone activity. […] What you eat may seem unrelated to the condition of your hand, but diet changes can actually help reduce the symptoms associated with Dupuytrens contracture. […] Smoking cessation can be an important step early on in the progression of the disease. […] Certain supplements can help reduce inflammation, which may play a role in managing the symptoms of Dupuytrens disease.

• #1 Best 5 Exercises for Dupuytren’s Contracture – Surrey Physio

  https://www.surreyphysio.co.uk/top-5/best-5-exercises-for-dupuytrens-contracture/

  Best 5 Exercises for Dupuytren’s Contracture […] 1. Finger Extensions […] Bend your whole finger backwards and hold the stretch. You can do this on any one or all of your fingers. This exercise will help mobilise your finger. Start with the outer fingers first like the 5th digit and progress inwards if the Dupuytrens is worse on the outside. Hold each stretch for 30 seconds, and repeat three times per finger, daily. […] 2. Active Finger Extensions […] Place your injured hand on a flat surface, lift all your fingers upwards off the surface together. Use this exercise to strengthen your finger tendons. Repeat twenty times on each hand, daily. […] 3. Hand Massage […] Use your thumb on your opposite hand to massage into the soft palm of your affected hand. Perform circular motions, and focus on areas of tightness or tenderness. This is a way to massage the palm of your hand. Perform for two minutes per day.

• #1 How to Relieve Dupuytren’s Contracture Pain

  https://www.healthline.com/health/dupuytrens-contracture/pain-relief-for-dupuytrens-contracture

  Steroid injections can help ease the inflammation and tenderness associated with Dupuytrens contracture nodules. […] An enzyme injection is a relatively new treatment for Dupuytrens contracture. […] While not necessary for everyone, treatments can help: slow the progression of the condition, provide pain relief, ease other discomfort. […] Options range from surgery and needling procedures to hand protection and potentially magnesium supplements.

• #1 Can You Massage Away Dupuytren’s Contracture? – Hands on Therapy

  https://handsots.com/can-you-massage-away-dupuytrens-contracture/

  It’s crucial to acknowledge that these massage techniques won’t eliminate Dupuytren’s disease. Once the fibers start pulling and causing significant contracture, consulting a hand surgeon becomes essential. Surgical intervention can release the affected fibers, offering relief in more severe cases. […] While I often emphasize non-surgical approaches, Dupuytren’s disease may necessitate surgery as it progresses. Consider consulting a trusted occupational therapist or certified hand therapist who can guide you to reputable hand surgeons if needed. This non-emergency condition allows you the time to research, gather information, and make informed decisions tailored to your lifestyle. […] In conclusion, these massage techniques serve as supplementary measures to maintain joint flexibility and alleviate discomfort associated with Dupuytren’s contracture.

• #1 Dupuytren Contracture: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16941-dupuytrens-contracture

  Your provider might inject collagenase into the nodules or cords to treat Dupuytren contracture. […] If your contracture is so severe that it interferes with your quality of life, you might need surgery. […] Theres no cure for Dupuytren contracture. However, almost all cases are manageable with treatment. […] Follow the instructions your provider gives you to manage your Dupuytren contracture symptoms. […] Conservative treatments sometimes take months to improve your symptoms. […] Talk to your provider before resuming any of your regular activities while youre recovering. […] Complications of Dupuytren contracture treatment can include: Pain. Nerve damage. Infection. Scarring. Damage to your blood vessels. Wound healing problems. […] The outlook for Dupuytren contracture is positive. Dupuytren contracture is extremely treatable and slow to develop. Even though theres no cure, there are many types of treatments available to relieve your symptoms.

• #1 Dupuytren’s Disease Treatment | Targeting Cancer AU & NZ

  https://www.targetingcancer.com.au/treatment-by-cancer-type/dupuytrens-disease/

  The number of treatments doctors use for Dupuytrens disease varies. People usually get a few treatments over several weeks. This ranges from 5-15 sessions. The radiation oncology team works out the right amount for each person. […] Recent advances mean radiation oncologists can effectively treat the Dupuytrens contracture while getting less radiation on healthy body parts. This means much fewer side effects. […] Before starting treatment, your radiation oncologist will talk to you about side effects and answer your questions. […] You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment option for you. […] The best person to talk to is a radiation oncologist. You can ask your doctor for a referral to find out if radiation treatment is right for you.

• #1 Best 5 Exercises for Dupuytren’s Contracture – Surrey Physio

  https://www.surreyphysio.co.uk/top-5/best-5-exercises-for-dupuytrens-contracture/

  4. Finger Abduction Active […] Start with your fingers together. Spread all your fingers wide apart from each other. Use this exercise to stretch your fingers out. Repeat twenty times, daily. […] 5. Finger Extension with Band […] Place a band around your fingers with your finger pads facing towards you. Extend your fingers against the resistance of the band. This is a strengthening exercise for the fingers. Hold for 30 seconds and repeat three times. […] What is the Prognosis for Dupuytren’s Contracture? […] The prognosis for Dupuytren’s contracture depends on the severity of your condition but it can be progressive and get worse, and often does. Recurrence Risk: The risk of recurrence is high, especially if you have another family member with the disease. If you do have a family history of Dupuytren’s contracture, talk to one of our physiotherapists about ways to reduce this risk. […] Exercises help slow down the rate of progression but wont cure the problem. Surgery can part-cure it, but the DC may come back. The success rate for surgery depends on several factors including age and severity of symptoms at the time of surgery; however, most patients are pleased with their results after undergoing an operation for Dupuytren’s Contracture.

• #1 Dupuytren’s contracture

  https://www.nhs.uk/conditions/dupuytrens-contracture/

  Dupuytren’s contracture does not usually need any treatment in the early stages. […] If it’s severe and you cannot straighten your fingers or use your hand normally, a GP may refer you to a specialist for treatment. […] The specialist will explain what the benefits and risks of each treatment option are. They’ll tell you what to expect afterwards, including advice on exercises to do. […] Your finger may not be completely straight after treatment, and might not be as strong and flexible as it used to be. […] The contracture could also come back after a few years. […] There are 3 main types of treatment: surgery to remove the affected tissue in the hand (fasciectomy), using a needle to make small cuts in the affected tissue (needle fasciotomy), surgery to remove the affected tissue and skin (dermofasciectomy).

• #2 Dupuytren’s Disease / Dupuytren’s Contracture | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/hand-program/dupuytrens-contracture

  The University of Michigan hand surgery team is not only experienced in traditional methods of treatment, but also offers a revolutionary new treatment approved by the FDA for those affected by Dupuytren’s disease. […] For a long time, treatment for Dupuytren’s Disease was limited to surgery. In recent years, however, new treatments have become available. Our specialized hand surgeons work with patients to identify the best course for their particular health and lifestyle. […] In mild cases, we recommend monitoring the thickened tissue for progression. If the disease progresses enough to cause problems with daily hand use, there are various treatment options. We recommend discussing these options with your hand surgeon. […] A procedure that removes the diseased tissue is called fasciectomy. This procedure is usually a very effective method of treatment. However, the recovery time can be long, especially if the skin is in bad condition and skin grafts are needed. Skin grafting requires months of recovery, and physical therapy may be necessary. Recurrence of the disease after this surgery is about 20%.

• #2 Mayo Clinic Minute: Treating Dupuytren contracture without surgery – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-treating-dupuytrens-contracture-without-surgery/

  Dupuytren contracture is a condition that causes one or more fingers to bend toward the palm of the hand. The affected fingers can’t straighten completely. It most often affects the two fingers farthest from the thumb. […] Patients with advanced disease will need an intervention to relieve the contracture. There are several treatment options. An enzyme injection is a newer, less invasive treatment. […] „It actually dissolves the thickened Palmer cords and fascia allowing the fingers to straighten,” she says. […] But if you’re unable to lay it flat because of the contractures in the fingers, then you would want to seek care with a hand surgeon specializing in Dupuytren’s disease.

• #2 Dupuytren Contracture Treatment & Management: Approach Considerations, Rehabilitation, Collagenase Injection

  https://emedicine.medscape.com/article/329414-treatment

  Stretching with the application of heat and ultrasonographic waves may be helpful in the early stages of Dupuytren contracture. […] The physical therapist also may recommend that the patient wear a custom splint or brace to stretch the fingers further. […] Prior to 2010, surgical intervention was the mainstay of treatment for Dupuytren disease despite a high rate of recurrence and complications. […] In 2010, the US Food and Drug Administration (FDA) approved collagenase Clostridium histolyticum (CCH; Xiaflex) at a dose of 0.58 mg per injection for the treatment of Dupuytren contracture in a single digit during a 30-day treatment cycle. […] The goal of surgical care is to excise the diseased fascia to help prevent progression of the disease. […] A patient should be referred to a hand surgeon if the MCP contracture is more than 30 or if any contracture of the PIP is present.

• #2 Best 5 Exercises for Dupuytren’s Contracture – Surrey Physio

  https://www.surreyphysio.co.uk/top-5/best-5-exercises-for-dupuytrens-contracture/

  Best 5 Exercises for Dupuytren’s Contracture […] 1. Finger Extensions […] Bend your whole finger backwards and hold the stretch. You can do this on any one or all of your fingers. This exercise will help mobilise your finger. Start with the outer fingers first like the 5th digit and progress inwards if the Dupuytrens is worse on the outside. Hold each stretch for 30 seconds, and repeat three times per finger, daily. […] 2. Active Finger Extensions […] Place your injured hand on a flat surface, lift all your fingers upwards off the surface together. Use this exercise to strengthen your finger tendons. Repeat twenty times on each hand, daily. […] 3. Hand Massage […] Use your thumb on your opposite hand to massage into the soft palm of your affected hand. Perform circular motions, and focus on areas of tightness or tenderness. This is a way to massage the palm of your hand. Perform for two minutes per day.

• #2 Dupuytren contracture

  https://dermnetnz.org/topics/dupuytren-contracture

  Non-operative treatment for mild Dupuytren contracture may include splinting (external fixation), which may reduce discomfort and lengthen the neurovascular bundle. It is uncertain if splinting, massage or hand exercises stop the progression of contractures. […] Intralesional steroid injections with lignocaine may reduce tenderness and disease progression, but these are not effective once cords and contractures have developed. […] Experimentally, 90% of patients treated with Clostridium histolyticum collagenase injections are reported to have achieved a full extension of the proximal interphalangeal (PIP) joint after a single treatment. […] Surgery is the main treatment for extensive contractures and impaired hand function. Indications for surgery are typically contractures of over 30-40 at the MCP joint and over 20 at the PIP joint. The aim is to restore function to the hands and reverse contractures in the fingers. The surgical procedures for Dupuytren contracture include: Fasciectomy (resection of the diseased cords or bands) and Fasciotomy (transection without removal of the diseased cords/bands).

• #2 Dupuytren Contracture Treatment & Management: Approach Considerations, Rehabilitation, Collagenase Injection

  https://emedicine.medscape.com/article/329414-treatment

  Recurrrence of disease is problematic across all treatment options. […] CCH and PNF have higher recurrence rates than fasciectomy, but the recurrence rate after 5 years with limited fasciectomy was 20.9%. […] A study by Leafblad et al that compared outcomes and costs of three Dupuytren contracture treatments concluded the following: CCH treatment resulted in the highest rate of reintervention at 2 years, comparable reintervention rates to PNF at 5 years, and the highest cumulative costs. […] PNF was the least expensive intervention and resulted in longer duration before reintervention compared with CCH. […] There is no general agreement on treatment recommendations regarding the choice between PNF, surgery, and CCH at this time among hand surgeons. […] Intralesional triamcinolone acetonide (Kenalog-40) injections of 40 mg/mL have yielded subjective improvement in the size of Dupuytren nodules in some patients. […] However, corticosteroid injections are associated with a high risk of complications, including fat atrophy and skin discoloration.

• #2 Dupuytren’s Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0701/p86.html

  Dupuytren’s disease is a progressive condition that causes the fibrous tissue of the palmar fascia to shorten and thicken. […] The disease initially can be managed with observation and non-surgical therapy. […] Steroid injection into the nodule has been shown to reduce the need for surgery. […] Surgical referral should be made when metacarpophalangeal joint contracture reaches 30 degrees or when proximal interphalangeal joint contracture occurs at any degree. […] Timing of surgical intervention varies, but surgery is usually performed when the metacarpophalangeal joint contracture exceeds 40 degrees or when the proximal interphalangeal joint contracture exceeds 20 degrees. […] In-office percutaneous needle aponeurotomy is an alternative to surgery. […] Surgery is recommended if function is impaired, contracture is progressing, or severe deformity is disabling.

• #2 Treatment Options for Dupuytren’s Disease: Tips and Tricks

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8849405/

  This article gives an overview of different treatment options for DD and each of their strengths and weaknesses and provides procedural tips. […] Percutaneous needle fasciotomy has an immediate improvement but a higher recurrence rate and rare tendon, or nerve complications. Collagenase injections require two visits and have an increased number of minor side effects, with rare tendon injuries. Limited fasciectomy removes the diseased tissue and has a prolonged recovery with a higher complication rate, but has the lowest recurrence rate. […] The mainstay of treatment remains limited fasciectomy (LF) surgery. Other treatments include percutaneous needle fasciotomy (PNF), open fasciotomy (OF), Clostridium collagenase histolyticum (CCH) injections, and dermofasciectomy (DF). […] Physical therapy treatments have had some success in treating established DD contractures. Hand therapy and orthotics are commonly prescribed after corrective DD treatment, but there is a lack of solid evidence to support this intervention.

• #3 Treating Dupuytrens Contracture | University of Utah Health

  https://healthcare.utah.edu/the-scope/health-library/all/2017/03/treating-dupuytrens-contracture

  Dr. Kazmers: The thought is that the recurrence rate is maybe somewhere between surgery, which is the lowest, and the collagenase is between that and the needle aponeurotomy, which probably has the highest rate of recurrence, maybe 50% in five years. […] Dr. Kazmers: Poke, dissolve, or operate. Those are the choices.

• #4 Dupuytren’s contracture

  https://www.nhs.uk/conditions/dupuytrens-contracture/

  A cut is made along your palm and finger so the surgeon can straighten it. […] Recovery time: 4 to 12 weeks. […] Lowest risk of contracture coming back. […] A needle is inserted into several places along your palm and finger to loosen and straighten it. […] Recovery time: up to 2 weeks. […] Contracture more likely to come back than with surgery. […] Similar to a fasciectomy, except an additional area of skin is removed; a skin graft from elsewhere in the body is used to replace the removed skin. […] Contractures less likely to come back than with a standard fasciectomy but recovery times can be longer.

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