Treatments for Dupuytren’s Contracture

When is treatment needed

Treatment is only needed when Dupuytren’s disease results in a contracture (bend) of the fingers or thumb towards the palm severe enough to cause you functional limitation. This is a very individual concept that will vary from patient to patient according to your job, hobbies, daily activities.

Our surgeons will help you understand if and what treatment may be helpful in your case.

What treatments are available

There is no cure to eliminate Dupuytren’s Disease.

Treatments consist in different forms of surgery to release palm, finger and thumb contractures once they develop and start causing functional difficulty:

  • Percutaneous Needle Fasciotomy: minimally invasive surgery under local anaesthetic

  • Fasciectomy: open surgery to remove the tight fibrous bands that have formed under your skin

  • Dermofasciectomy: more radical open surgery in which some skin is removed along with the fibrous bands, and reconstructed with skin grafts

Our surgeons will help you understand what type of surgery is best for you.

Read below for more information on each type of surgery

Types of surgery for Dupuytren’s contracture

  • A needle fasciotomy is a minimally invasive operation performed under local anaesthetic. After numbing your skin in multiple points along the tight cords that are causing your finger contracture, we use the tip of a needle to go through the skin and cut the the cord, so that the contracture can be released.

    It is a very quick operation, the result is immediate, and the recovery after it is also very quick - patients can start using their hand right away as there are no large wounds. The small skin tears heal by themselves in a few days. In most cases no physiotherapy is needed.

    It is not indicated for all types of contractures. If you have very diffuse or bulky disease, or if the middle joints of your fingers are affected, we may advised that open surgery has better chances of a satisfactory and lasting result. Needle fasciotomy has a higher risk of the contracture coming back with time, but it is the preferred option of many patients when their priority is a quick recovery or avoiding major surgery.

    You can read our full leaflet on Percutaneous Needle Fasciotomy, including post-operative care and risks, by clicking here.

  • In a fasciectomy, we open the skin of your palm and finger with ziz-zag wounds, and remove the tight fibrous tissue (cords) which is causing the contracture. The wounds are stitched up, and after surgery you will have a bulky dressing and a plaster cast to help the finger(s) remain straight. The stitches are removed after 2 weeks. When the plaster cast is removed, you will be provided with a custom-made splint to wear at night time for a few months. This helps preventing your finger from bending in again.

    You will need hand therapy to regain movement in your fingers, as they will initially be very stiff, and to help maintain the extension achieved with surgery. Overall, recovery tipically takes around two months, sometimes longer.

    This surgery is normally performed as a day-case procedure, under general anaesthesia (asleep), or in selected case under regional block (with your arm anaesthetised but you being awake).

    You can read our full leaflet on Fasciectomy, including post-opertive care and risks, by clicking here.

  • A dermofasciectomy is the most radical type of open surgery for Dupuytren’s contracture. It has a longer recovery time, and higher risks of complications, but it has the lowest risk of contractures coming back and often the best option in cases of recurrent disease, of extensive diseIse with severe skin involvement, or as a primary option in younger patients with more aggressive disease.

    n addition to removing the tight fibrous tissue (cords) which has developed in your palm and fingers, we also remove some skin along with it. We then use a “skin graft” to replace the skin that has been removed. It requires an additional wound where we take the graft from - usually your forearm - which is closed directly. The other wounds in your hand are stitched up, and after surgery you will have a bulky dressing and a plaster cast to help the finger(s) remain straight. The stitches are removed after 2 weeks. When the plaster cast is removed, you will be provided with a custom-made splint to wear at night time for a few months. This helps preventing your finger from bending in again.

    You will need hand therapy to regain movement in your fingers, as they will initially be very stiff, and to help maintain the extension achieved with surgery. Overall, recovery typically takes around three months, sometimes longer.

    This surgery is normally performed as a day-case procedure, under general anaesthesia (asleep).

    You can read our full leaflet on Dermofasciectomy, including post-opertive care and risks, by clicking here.

Please see our consultation and fees page for information on how surgery is organised and estimates of costs of the procedures.

Other treatments?

Surgery is currently the only available option to correct digits contractures from Dupuytren’s disease. No treatment is currently available to stop or slow down the progression of Dupuytren’s disease.

  • Collagenase from Clostridius histolyticum is an enzyme that is injected into the cords of Dupuytren’s disease and breaks them down without needing surgery. Collagenase has been withdrawn from the market worldwide except the USA since 2020 and therefore is not any longer available to patients anywhere in the UK, neither privately nor in the NHS

  • Steroid injections have only very limited indication in the treatment of Dupuytren’s disease

  • A clinical trial based in Oxford and Edinburgh showed that this drug, injected into nodules, can slow down the progression of Dupuytren’s Disease. The results of the trial are currently being reviewed by the Medicines and Healthcare products Regulatory Agency (MHRA), and the drug is not yet approved for use in Dupuytren’s Disease in the general population.

  • There are reports that low dose radiotherapy may slow down the progression of Dupuytren’s Disease, but the available results of clinical trials do not currently provide conclusive evidence. The progression of disease reported in patients who have had radiotherapy appears similar to that expected in patients who did not receive radiotherapy LINK1 LINK2 . We do not generally recommend radiotherapy as a treatment to prevent the progression of Dupuytren’s Disease, but we are happy to provide contact details of doctors who may offer to discuss this further and offer radiotherapy in select cases.

  • Physiotherapy alone cannot correct Dupuytren’s contractures, and cannot prevent the progression of disease.

    Physiotherapy is essential after open surgery to correct Dupuytren’s contractures. It involves a combination of tailored exercises and splinting, designed to resolve post-operative stiffness and maintain the extension of your digits achieved with surgery. We will organise post-operative physiotherapy as part of the comprehensive package of care that will be agreed for your operation. Post-operative physiotherapy will involve a combination of splinting with custom-made splints, and exercises you will need to perform daily.

    Here you can download additional information on splints and on a standard exercises protocol.

    Physiotherapy is not usually needed after percutaneous needle fasciotomy, even if occasionally we may recommend a post-operative night splint.

FAQs

  • Yes, this is possible. Surgery corrects the contracture, but is not a definitive cure for Dupuytren’s disease. Even if surgery is successful, in some cases new contractures can develop to the same fingers (recurrence) or to other finger (progression) over the years.

  • Dupuyten’s disease is a benign condition - it is not cancer - and can safely be managed conservatively. If you think that your hands function well enough and the contractures of your digits do not cause too much discomfort, then no treatment is needed.

  • Dupuytren’s disease is a progressive condition - but its behaviour in each patient is very unpredictable. We know that of 10 patients who develop early signs of Dupuytren’s disease, only 1 in 10 need surgery by 10 years, and 3 in 10 by 20 years.

    While there are some factors that may make it more likely for Dupuytren’s disease to progress in some patients (such as young age, familiarity, having associate conditions such as Ledderose disease, La Peyronie’s disease or Garrod’s pads), it is impossible to predict if the disease will indeed progress.

  • In most cases the diagnosis of Dupuytren’s disease is clinical - no scan is needed.

    Occasionally we may recommend a scan (ultrasound scan or MRI) or X-rays if we have a doubt or to investigate additional conditions.

    Please notice that any investigation has costs the are additional to the consultation fee, and may need to be organsed on a different day or at a different hospital.

  • Usually blood tests are not needed in the diagnosis or treatment of Dupuytren’s disease.

  • Duputren’s disease is not usually a painful condition - but the nodules Dupuytren’s disease in the palm and fingers are sometimes painful in the phase in which they are growing. There is no treatment for this other than painkillers, and the pain usually settles in 1 to 2 year. Surgery for panful nodules is not indicated.

  • While exercising your hands is a good practice, hand physiotherapy and exercising in general has no impact on Dupuytren’s disease - it cannot improve it and it does not influence its progression.

    Post-operative hand physiotherapy is instead an essential component of your surgical treatment.

  • A healthy diet is always advisable - but ther is no proof that any dietary changes or supplements affect Dupuytren’s disease.