Hand surgery

DUPUYTREN’S CONTRACTURE – TREATMENT OPTIONS FOR DUPUYTREN’S DISEASE

Sometimes our hands just can’t grip anymore. But a firm handshake is important in life. And even a heavy chest of drawers needs a strong hand when moving house. If our most valuable tool no longer plays along, it may be due to Dupuytren’s contracture. Small nodules in the palm of the hand and clearly marked finger strands indicate this hand disorder. Men aged 50 and over are most commonly affected.

Dupuytren’s disease often runs in families, but a clear genetic cause has not yet been found. It often occurs in conjunction with diabetes or is associated with the long-term use of certain medications. Injuries to the hand can also trigger Dupuytren’s disease.

Our hand surgery specialist, Prof Dr Germann, will recommend a suitable treatment for Dupuytren’s disease at the ETHIANUM after taking a detailed medical history. And this does not necessarily have to mean an operation. As the disease can recur again and again, you should contact Prof Dr Germann at an early stage if you have symptoms. Read which conservative and treatment methods are available for Dupuytren’s contracture and which surgical procedures we use.

Dupuytren’s contracture – development and stages of the disease

The connective tissue under the skin of the palms protects the underlying nerves and tendons. However, benign growths can occur in this so-called fascial layer above the flexor tendons. These thickenings hinder the extension of one or more fingers. The tissue above the tendons in the palm gradually shrinks. As a result, the affected fingers remain curved. They can no longer be extended. This causes pain and, over time, impaired hand function.

Dupuytren’s disease, also known as Dupuytren’s contracture, progresses in phases. Some sufferers have no symptoms for a long time. Suddenly the disease worsens. For some, a nodule formation remains for the rest of their lives, which does not cause any further problems and does not require surgery.

Dupuytren’s disease develops in four stages. The first stage is characterised by fibrosis with nodules or flat hardening. There is already a slight contracture. In the second and third stages, the tissue hardens further and further. The ring finger and little finger are usually affected. This results in a deformity. The flexion contracture is already more pronounced. A curvature of between approx. 45 and 135° may be present. In the fourth stage, permanent damage to the joints of the affected fingers can occur without treatment. These can no longer be bent or cannot be extended.

Dupuytren’s disease – the most promising surgical options

At the ETHIANUM, we usually only recommend surgery for Dupuytren’s disease when the affected finger can no longer be extended. As an internationally recognised expert in hand surgery and specialist in plastic surgery, Prof. Dr Germann also says: “However, if the typical lump formation in the palm is painful, we operate on the lump even if the Dupuytren’s contracture is not yet pronounced.”

The method of injecting enzymes to break up the cords, which has been heavily advertised in the short term, has been shown in studies to be fraught with considerable side effects, so we do not recommend this procedure.

The following surgical methods are used in the treatment of Dupuytren’s disease at the Heidelberg Hand Surgery Centre at the ETHIANUM:

1. Partial aponeurectomy: The affected parts of the connective tissue are removed. If Dupuytren’s contracture is already at an advanced stage, it may be necessary to cut the cord first.
2. Surgery using the wide-awake method

In this surgical procedure, the client remains conscious during the local anaesthetic and can actively participate in the success of the procedure by performing trial movements during the operation.