Reducing the Risk of Dupuytren RecurrenceStudies have gone back and forth on the best way to prevent recurrence of the nodules that form with Dupuytren contracture. Reported recurrence rates are as high as 50 per cent.
Dupuytren's contracture is a fairly common disorder of the fingers. The condition commonly first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytren contracture usually affects only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized.
This condition is seven times more common in men than women. Although more common in men of Scottish, Scandinavian, Irish, or Eastern European ancestry researchers agree that genes are not a direct cause of this disease, but predisposes them to this condition. The disorder may occur suddenly but more commonly progresses slowly over a period of years. The disease usually doesn't cause symptoms until after the age of 40.
Successful treatment usually requires invasive procedures such as steroid injections or surgical release of the fascia. There are known advantages and disadvantages for each approach. For example, percutaneous needle aponeurotomy (PNA) has few complications and a quick recovery time. Patients report little pain and improved hand function. But the recurrence rate is high.
The procedure involves slipping a surgical needle under the skin and making multiple incisions along the fascia to divide the cord up. Soft tissue release is done until the patient's finger can be fully straightened.
Surgery to slice the palm open and remove the diseased tissue has a lower recurrence rate compared with percutaneous needle aponeurotomy (PNA). But the open incision technique called dermofasciectomy leaves scars. Not everyone is a good candidate for dermofasciectomy. Older age and other health problems can prevent surgery from being an option.
Without a one-best-treatment approach, surgeons continue to look for ways to obtain patient satisfaction and low recurrence rate. In this study, one surgeon compared two different treatments for Dupuytren disease. One group of patients just had percutaneous needle aponeurotomy (PNA).
The second group had the PNA procedure followed immediately by injection of triamcinolone acetonide (TA). TA injections were repeated six weeks and three months after the first injection. TA injection is a type of steroid (antiinflammatory). The injections were placed right into the contracted (tight) cords caused by the Dupuytren disease.
Results were measured by comparing finger motion (extension) before and after treatment. Overall joint motion was better in the group who received the combined PNA procedure and TA injection. The joint most affected (in a positive or beneficial way) by this combined approach was the proximal interphalangeal (PIP) joint. The PIP joint is the middle knuckle of the finger.
Although this study only presents short-term results, there is limited evidence that TA injections may have the ability to provide long-term correction of joint contracture. Results were promising enough after six months to encourage further study using TA injections for Dupuytren contractures. The authors mention the need to assess patient satisfaction as an outcome in all future treatment selections and studies.
Catherine McMillan, MSc, and Paul Binhammer, MD. Steroid Injection and Needle Aponeurotomy for Dupuytren Contracture: A Randomized, Controlled Study. In The Journal of Hand Surgery. July 2012. Vol. 37A. No. 7. Pp. 1307-1312.
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