Houston Methodist. Leading Medicine

Hand FAQ

Question:

I've been told that treatment for Dupuytren disease of the hand is a "why bother" proposition -- that the results are 50/50 and the problem comes back. Is this really true?

Answer:

There is some truth to that statement. Studies do show a high recurrence rate for this problem. Treatment isn't curative. People with severe joint contractures seem to be more likely to "fail" treatment. They either don't get the motion back they expected, don't get the pain relief needed, or end up having more surgery. No hard and fast rule exists as to when surgery is needed. But the sooner a contracture is treated, the better the results of a return to full function. Many patients are instructed to keep an eye on the disease and return for follow-up once their "tabletop test" shows light between their hand and the table. The tabletop test is done by putting your hand flat on a table. If you can see sunlight between your hand and the table, it's time to start to considering treatment for the condition. Surgery is usually recommended when the MCP joint (at the knuckle) of the finger reaches 30 degrees of flexion. When patients have severe problems and require surgery at a younger age, the problem often comes back later in life. Studies show that patients with more severe disease (especially affecting the proximal interphalangeal (PIP) joints) have a higher risk of disease recurrence. In fact, for all treatment approaches (surgical and nonsurgical), the metacarpophalangeal (MCP) joints are easier to treat with better outcomes and fewer cases of recurrence. As many as half of all patients who have surgery report return of flexion contractures within five years of surgery. Patients with PIP contractures seem to have the highest recurrence rates. There are complications of treatment to consider as well. Complications of this surgery can include permanent nerve damage, joint pain and stiffness, hematoma (pocket of blood), infections, and poor wound healing. Patients who have the newer, less invasive injection treatment to dissolve the contractures report problems, too. Most of these are minor side effects. There are very few major or long-term complications with this new treatment. During the control trials conducted with patients, most people had a local skin reaction (swelling, redness, skin tears, itching or stinging) where the injection went into the skin. A small number of more serious problems developed in a few patients including skin infection, tendon rupture, finger deformity, complex regional pain syndrome (pain and stiffness), and hives that had to be treated with medication. Treatment does not always fully restore range-of-motion and function but it usually increases the ability to extend (straighten) the affected fingers. And that may be enough for some patients to pursue some kind of treatment. A hand surgeon who specializes in this type of problem may be able to give you a better idea of what might work best for your particular case based on the severity of the problem. Spencer J. Stanbury, MD, and Warren C. Hammert, MD. Dupuytren Contracture. In The Journal of Hand Surgery. December 2011. Vol. 36A. No. 12. Pp. 2038-2040.

*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.
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