When do you recommend having surgery for Dupuytren disease?
Dupuytren's contracture forms when the palmar fascia begins to thicken and tighten, causing the fingers to bend. The palmar fascia lies under the skin on the palm of the hands and fingers. This fascia is a thin sheet of connective tissue shaped somewhat like a triangle. It covers the tendons of the palm of the hand and holds them in place. It also prevents the fingers from bending too far backward when pressure is placed against the front of the fingers. The fascia separates into thin bands of tissue at the fingers. These bands continue into the fingers where they wrap around the joints and bones.
The Dupuytren condition 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.
A partial palmar fasciectomy remains the "gold standard" surgical procedure, although at earlier stages of this disease a less invasive surgical procedure called a needle aponeurectomy may be done. One reason to have surgery done sooner than later is when the condition is painful.
Most people with Dupuytren disease don't complain of pain. They are bothered much more by the loss of finger motion, especially extension (straightening the affected fingers). But sometimes the nodules that form are painful. A recent study showed that tiny nerve fibers in or across the fibrous tissue is the likely cause of painful symptoms. Early surgery to remove the nodules and nerve tissue within the fibrous tissue does put a stop to the pain.
Another reason to consider surgery is the loss of finger extension that can forms. 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 together with fine stitches. Surgical treatment does not stop or cure this disease process, so recurrence is possible.
A. von Campe, MD, et al. Painful Nodules and Cords in Dupuytren Disease. In The Journal of Hand Surgery. July 2012. Vol.37A. No. 7. Pp. 1313-1318.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.