Guide to Treatment for Dupuytren’s Contracture

From Dr. Z - Carpal tunnel syndrome specialist

Treatment for Dupuytren’s Contracture

Even though there are good treatments for Dupuytren’s Contracture, you can't technically "cure" it. That's because it’s a disorder with no cure.


However, Dupuytren’s Contracture treatments can be so effective that the problem doesn’t bother you anymore. In fact, most times the hand is restored to normal again. 


An update to this report is published on 6 May 2022 regarding a promising experimental drug. See details about using adalimumab below.


What is Dupuytren’s contracture? 

A recent Washington Post article says Dupuytren's Contracture is "the most common crippling hand condition’ you’ve never heard of."  Unless you have it, you probably don't know what it is.


Dupuytren’s Contracture (doctors also call it Dupuytren’s disease or Dupuytren’s tenosynovitis) is an abnormal condition of the hand. It was first described by Baron Guillaume Dupuytren , a French anatomist and army surgeon. Dr. Dupuytren gained fame from treating Napoleon Bonaparte's hemorrhoids. But today, he’s best known for his namesake condition.


Treatment for Dupuytren's Contracture was developed after years of research. It affects about 5% of the adult population in the United States. It’s more prominent in men over 50 years old. Also, Caucasians are most likely to be affected, specifically those of northern European descent. It’s not very common to find this condition in people of Asian or African heritage. 

endoscopic carpal tunnel surgery

Do you have these symptoms?

Before seeking a treatment for Dupuytren's Contracture, make sure you have it. This is a condition where one or more fingers are bent in a flexed state when resting. It often happens in both hands. 

At first, you may see thick cords in the palm of your hand. The cords are in line with the fingers. Then, in time, a lump or nodule may form on the cord. The lump may be more tender than actually painful. 
  • Usually the cords and nodules eventually grow in size. But it’s important to understand they are not cancerous. 

  • With more time, a Dupuytren’s patient cannot straighten the affected finger or fingers. In fact, just pressing the palm side of the hand flat on a table is difficult or even impossible. 

  • Most people with Dupuytren's Contracture cannot easily put their hands in their pockets. They also have a hard time grasping large items.

  • Even though you can't cure Dupuytren’s Contracture, luckily it's normally not painful. But you may feel itching or aching in the palm. 

  • Most cases involve the ring finger. But it may occur in the pinky and middle fingers as well.
carpal tunnel space

Risk factors

No one knows why you get this condition in the first place. This unknown factor is the main reason there's only a treatment for Dupuytren’s Contracture, but there's no cure. 

We know that there is a higher association of Dupuytren’s Contracture in people with a history of:
  • a family member with the disease
  • smoking
  • alcoholism
  • thyroid or liver disease
  • diabetes
  • epilepsy
  • previous hand injury

The Xiaflex treatment for Dupuytren’s Contracture?

As already mentioned above, you cannot cure this condition. But there's a good treatment for Dupuytren’s Contracture your doctor can give you. It's very effective, and most times it even restores hand function to near-normal levels.

In 2010 the Food and Drug Administration approved a new drug for Dupuytren’s Contracture. Its name is Xiaflex (clostridial collagenase). 

Xiaflex is an injectable drug that breaks down any excess collagen that causes shortening and thickening in the palm. 

Usually patients only require one shot to see great results. But more advanced conditions of Dupuytren’s might need a series of injections to see good results. 
Xiaflex

How Xiaflex is used

Xiaflex is a 2-step treatment for Dupuytren’s Contracture. It involves the following: 

 

  1. First, the doctor injects Xiaflex into a particular cord or node in the palm. 

  2. On the following day, the patient gets another injection of an anesthetic agent. This numbs the area. Then the doctor stretches the affected finger. The doctor stretches the finger so much that the cord breaks up. 

 


The injection and stretching process may need to be repeated again in four weeks. If necessary, the doctor can do this up to 3 times per cord at 4 week intervals


After a few years of use around the world, Xiaflex results show that it’s as good as having surgery. In most cases, it's better. Also, recovery time and physical therapy are not nearly as long as surgery. 


Unfortunately, since the drug is still relatively new, no one is certain what the re-occurrence rate is yet. Also, no one is certain what the long term effects may be, if any exist.

Problems with Xiaflex

The Xiaflex treatment for Dupuytren’s Contracture isn't perfect. In fact, it has some side effects.
  • Some people may be allergic to Xiaflex. Severe allergies to the drug can be potentially dangerous.

  • Other patients may experience severe side effects. These include swelling, bruising, bleeding, and tenderness or pain at the injection site. After Xiaflex injections, some patients may even develop symptoms of carpal tunnel syndrome.

  • While Xiaflex works in most patients, there are some who see no results whatsoever from the treatment. In other words, the treatment failed.
hand bruising

Alternatives to Xiaflex

If Xiaflex fails, you can try another treatment for Dupuytren’s Contracture. The treatment options available are:

 

  • New research with an arthritis drug
  • Steroid injections
  • Needle fasciotomy
  • Surgery

New research with an arthritis drug

New research with an experimental drug was reported on 29 April 2022 as the next best treatment for Dupuytren's contracture. The drug adalimumab has actually been around for many years to treat rheumatoid arthritis. But now it shows tremendous promise for Dupuytren's contracture.


Doctors report that one injection of the drug into the hand every 3 months for a year softens and reduces nodule size. The effects last up to 9 months later. As a result, the hand normalizes. But if the nodules return, the patient may need another course of injections.


Furthermore, adalimumab injections are most effective in patients with early-stage Dupuytren's disease. No results were reported in patients with a longer-term of the disease. Note: this treatment is still experimental as of this writing.

Steroid injections for Dupuytren’s Contracture

Only a few years ago doctors considered corticosteroid injections as the best treatment for Dupuytren’s Contracture. But that was then. 

Today, corticosteroid (or simply, “steroid”) shots into the palm are now the second-line treatment for Dupuytren’s Contracture when Xiaflex fails. 

Doctors inject steroids directly into the affected tissue. It reduces inflammation and gives the tissue time to repair itself. A second steroid shot is normally followed by a course of physical therapy. The therapy strengthens the hand. It also helps increase the affected finger’s range of motion. But usually if Xiaflex doesn't work, steroid injections won't work either.

Needle fasciotomy

Sometimes a contracted cord can weaken just by puncturing it. The doctor can insert a needle into the cord and make several puncture holes into it. 

First you need a local anesthetic because the puncturing process can be quite painful. After all, the palm of the hand is quite sensitive! 

Unfortunately, the re-occurrence rate of needle fasciotomy is greater than either steroid injections or Xiaflex. That's why this treatment for Dupuytren’s Contracture is seldom used today.
dupuytrens surgery

Surgery

Fasciotomy

This is a more radical treatment for Dupuytren’s Contracture:
  • Subtotal palmar fasciectomy is when the doctor uses a local anesthetic to numb your hand. Then the doctor opens the skin over the affected finger’s tendon. The doctor divides the thickened cord several times. But the tissue is not removed. Dividing it can lessen the contracture. It can also allow the affected finger to move better. 

  • After the operation the doctor leaves the incision open so it can heal gradually. A hand splint is needed during the entire recovery period.

Subtotal palmar fasciectomy 

This is by far the most radical treatment for Dupuytren’s Contracture, and performed only when absolutely necessary:
  • In this operation the doctor makes an incision, as in a fasciotomy. But this time the doctor removes enough abnormal tissue (and even the cord) to straighten the finger.

  • In some cases, the surgical site is left open to gradually heal on its own. But in other cases, the patient may need a skin graft. The graft will be taken from healthy skin somewhere else on your body such as the buttock or inner thigh. A splint is usually worn afterward, and during much of the recovery period.

  • This operation is more extensive than a fasciotomy. It requires more wound care and more extensive rehabilitation. Accordingly, it requires more extensive patient effort during therapy because the healing time is much longer.

Summary

Even though there's no cure, there are several treatments for Dupuytren’s Contracture. The most effective remedy is Xiaflex. It can be used to lessen the contracture and bring the hand back to normal again. Xiaflex is a huge advancement in this field and requires minimal therapy. Surgery usually is the last option a patient should resort to.