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This is a common problem that affects the hand. Typically patients notice nodules or cords of tissue in the hand sometimes associated with small skin pits. The nodules are not usually painful but can be a nuisance and interfere with function.
Sometimes patients notice that the fingers start to bend and they are unable to fully straighten them. This can make it awkward when trying to do normal everyday tasks such as washing the face, grasping objects, shaking hands, putting hands into pockets and trying to wear gloves.
Before needle treatment for Dupuytren's disease
What causes Dupuytren's Disease?
Genetic or inherited factors are the commonest cause. It often runs in families.
Other factors include alcohol, smoking, epilepsy medication, injury to the hand.
How does the disease progress?
The rate and severity of progression of Dupuytrens disease varies between individuals. Some joints in the hand tolerate being bent better than others.
It is worth seeking advice before the finger joints become stuck in a bent position for a long period of time as it may reduce the chances of them being fully corrected.
What types of treatments are there?
In some cases monitoring the disease over a few months may be appropriate. This is also known as conservative management. Splints are not thought to halt disease progression.
Other modalities of treatment include, needle aponeurotomy, enzyme injection treatment or surgery.
Minimally invasive treatment for Dupuytrens Disease (Needle Aponeurotomy / Needle release / Needle fasciotomy)
Certain patterns of disease in the hand are most suited to a "pinhole technique" of treatment.
This is a procedure performed as an outpatient under a carefully administered local anaesthetic technique. It has a low complication rate and the return to normal use of the hand is usually within 24 to 48 hours.
The recurrence of the disease is slightly higher than if more invasive surgery is undertaken but if the disease recurs, further needle treatment can be performed. There is a high patient satisfaction rate with this treatment.
After needle treatment for Dupuytren's disease
After needle treatment
Enzyme injection treatment for Dupuytren’s Disease
This type of treatment involves the injection of an enzyme known as collagenase into the diseased area of the hand. The cord is then snapped by gentle manipulation the following day.
It is not widely available as an NHS treatment due to the cost of the drug.
Open Surgery for Dupuytren's Disease
There are different types of open surgery that depend on the pattern of disease in the hand. Small painful nodules can be removed under a local anaesthetic. The more extensive the disease in the hand, the more likely it is that a regional block type of anaesthetic will be needed.
This is not a general anaesthetic but is one that will temporarily numb the whole arm. It provides good postoperative pain relief and wears off after a few hours. Recovery is quicker than with a general anaesthetic.
The different types of operation include segmental fasciectomy, fasciectomy, dermofasciectomy (requiring a skin graft), joint fusion and as a last resort amputation.
Your specialist will be able to advise which is most appropriate in your individual circumstances.
Risks of surgery
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