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Treatment | Hand | Dupuytren

Dupuytren

What sounds complex is a hand disease that has been known for almost 200 years. The name goes back to the descriptor Baron Guillaume Dupuytren. The connective tissue layer between the skin and the tendons contracts and bends for reasons that are not completely understood, which leads to considerable movement restrictions. A familial cluster is described. There is also an increased risk for diabetes and certain liver diseases. In the beginning, nodular, painless changes occur in the palm. Since the disease is not very common, the changes are interpreted as calluses. At this stage no treatment is usually necessary. As the disease progresses, the affected finger bends more and more, so that full extension is no longer possible.  In severe cases, there is a combined limitation of the middle and base joints.

How can it be treated?

Since the disease is usually painless and the cause is not fully understood, the functional treatment is the main focus. The restricting strand must be severed either mechanically or medically. In needle fasciotomy, the strand is weakened by punctures so that the finger can be stretched again. The disadvantage of this technique is that the recurrence of the bending occurs relatively quickly. During the operation (selective fasciectomy), the strand in the affected part is removed. This is much more invasive, but has the advantage that the recurrence occurs much later or not at all. In the third technique, the injection with Xiapex (reg), parts of the strand are dissolved, creating predetermined breaking points which allow the strand and thus the finger to be stretched after 24 hours.

Am I a candidate for an injection or do I need surgery?

The more the finger is bent, the more complex the procedure. In principle, all techniques are applicable. In the case of minor contractures, less incisive, non-surgical techniques such as xiapex reg. treatment and needle fasciotomy can be used. In the case of severe findings, the joints themselves are often also affected, which cannot be treated with a pure injection treatment. In this case, surgery is the method of choice. Finally, it can only be decided together with the patient during the consultation which technique will be used.

Finger in increasing flexion position

What can I expect?

Dupuytren’s disease cannot be cured. The focus of the treatment is on the correction of the movement restriction. In very complex cases with several preliminary interventions, a complete stretching may not be possible. Due to the wide range of therapy options, however, we have a good range of instruments for successful treatment. It is important to us to discuss the expected results in detail during our consultation before therapies are applied.

What happens during consultation hours?

During the initial consultation we will confirm the new diagnosis. In addition to the conversation and the examination, imaging is rarely used. Magnetic resonance examinations or similarly complex examinations are not necessary or purposeful. Depending on the extent of the contracture, we will develop a treatment plan which includes local measures after the operation/intervention hand therapy. An injection/operation will be performed later.

What's the surgery procedure?

Depending on the extent of the disease, the operating area is correspondingly large. If the first manifestation occurs and only one finger is affected, surgery can usually be performed on an outpatient basis without general anesthesia. Depending on the joint region and the technique used, the interventions last between 45 and 90 minutes. Sometimes additional soft tissue corrections or joint extensions (arthrolysis) are necessary. The exact surgical technique to be used will be discussed during the consultation on the basis of anatomical sketches.

How is the injection applied?

Injection therapy with Xiapex takes place in two sessions. In the first session, the medication is injected and after at least 24 hours, the fingers are stretched in a second session with regional anaesthesia. In extensive cases, skin tears and bruises may occur, but these can be easily treated.

What about the follow-up treatment?

Since every intervention, no matter how small, involves a certain risk of complications, certain measures should be observed. The first few days you will feel normal, timely pain, which can be relieved with painkillers. Immobilization by means of splints, which are worn only at night, takes place over 4-6 weeks. Outpatient wound checks are carried out depending on the extent. Already in the first days a hand therapeutic accompaniment is initiated. The aim of the follow-up treatment is to enable early full movement with great safety and freedom from pain. The follow-up treatment is already discussed in the first consultation, so that you can already plan the postoperative phase and any help for everyday life and inability to work can be organized.

What are the risks?

Every intervention, however small, involves a certain risk of complications, since an operation or intervention in the broadest sense always leads to tissue injuries. A complication does not necessarily occur due to an error. Rather, the human body reacts individually and has certain tendencies to complications. The initial clarifying discussion serves to address such predispositions and personal risk factors and to take appropriate precautions.

General risks:

  • Postoperative bleeding
  • wound healing disorders
  • infections
  • excessive scars
  • Thromboses and embolisms.

Specific risks of Dupuytren’s disease:

  • Nerve or tendon injuries
  • Bruises and wound healing disorders occur more frequently than in other operations due to the expansion.
  • The recurrence of contracture depends on the chosen technique, personal predisposition and extent of the disease.

 

Would you like to know more?

Do you have the impression that you have a Dupuytren’s disease or have already been diagnosed?

We will be happy to advise you within the framework of an initial consultation on referral by your family doctor or directly with us. Please note whether you are in an HMO or other general practitioner model and inform your general practitioner.  During the initial consultation, we will work out the diagnosis together and initiate the appropriate form of therapy. An operation will always take place later and should be well weighed.

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