Dupuytren’s contracture is a disease of the fascial layer beneath the skin of the palm. This disease can cause severe hand deformity, compromise hand function, and limit many daily activities. Dr. Leonard Gordon is an orthopaedic hand specialist who practices at Hand and Microsurgery Medical Group and specializes in the treatment of Dupuytren’s disease to residents of San Francisco, California.
Dupuytren's Disease Specialist San Francisco
What is Dupuytren's Disease?
Dupuytren’s disease, also known as Dupuytren’s contracture is a hand deformity. It affects a thick layer of tissue that lies under the skin of the palm. Over a period of years, nodules, bands, and cords of tissue gradually form under the skin. These thick cords can pull one of more fingers into a flexed position so that the fingers cannot be straightened, ultimately getting in the way of normal hand function. This affects many everyday activities – such as holding a tray or putting the hand in a pocket. Dupuytren’s disease most often affects the ring finger and other small fingers and may occur in one or both hands.
Commonality of Dupuytren's Disease
Dupuytren’s Disease is a common condition and an estimated 3 out of 10,000 people are diagnosed with the disease each year. Any person who has been diagnosed with this condition is eligible for surgery.
However, ideally, medical professionals recommend surgery only when the chords in the fibrous tissues of the hand have impaired the individual’s ability to use the hand effectively. If you have had other surgeries in the past, it is best to consult Dr. Gordon at our Hand and Microsurgery Medical Group clinic before you take a decision regarding treatment.
What are the
risk factors involved?
The cause of Dupuytren's disease is unknown, but it is most likely to affect older men of Northern European descent. The contracture typically begins to develop after age 50, and men who have Dupuytren's disease usually have more severe contractures than women with the condition. There may be a genetic component, as Dupuytren's disease tends to run in families. Smoking and alcohol use increase the risk of Dupuytren's disease and people with diabetes are more likely to develop the condition.
How is Dupuytren's Disease Treated?
The goal of Dupuytren’s disease treatment is to remove or release the tight, diseased cords of tissue that cause the contracture. Physical therapy and stretches have not proven to be helpful and have not been shown to slow the progression of contractures. There are several successful treatment options, which include needling or needle aponeurotomy which involves puncturing the skin to break the tissue cord. This method has a high incidence of recurrence but alleviates the problem temporarily. Injections of an enzyme called Collagenase may soften and weaken the cord, allowing the doctor to stretch the finger out. This is controversial with a high incidence of recurrence and is indicated in certain anatomic areas and clinical situations.
When is surgery used?
Surgery is often recommended for contractors that are causing significant functional problems. The surgeon will go in and remove the tight band of tissue and may need to rearrange the skin to allow release by specialized incisions called Z-Plasty, and occasionally in very severe cases skin grafting may be needed. Surgery is done as an outpatient procedure and takes about an hour. Hand therapy is recommended post-operatively.
How long is recovery?
This is a relatively low-risk surgery and you should be able to go home the day after the surgery. However, it may take anywhere between 2 months and 6 months to fully regain flexibility and strength in your hand. This depends on the extensiveness of the treatment.
Suture Removal and Hand Exercise
The sutures will be in place for at least 1-2 weeks after the surgery. You may need to use bandages to hold your fingers together for the first few weeks, to avoid splinting. Once your scar heals and scabs, gently massage the scarred area to stimulate blood flow in the treated area of the hand.
Usually, patients take 2-4 weeks off work to heal. When using your hand, be sure to go slow and make incremental movements each day. Dr. Gordon will provide a list of hand exercises which you need to follow daily. Hand therapy may be recommended to increase movement range and flexibility.
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