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Restoring Form and Function to Patients with Dupuytren's Contracture

Dupuytren’s contracture, also known as palmar fibromatosis, is a hand deformity marked by the gradual thickening of the tissue beneath the surface of the palm.  As this tissue thickens, lumps, or nodules, eventually begin to form.  Over time, these nodules harden into tough, thick cords that contract, pulling the fingers most often the ring and pinkie fingers back into a permanently curled position.  While not dangerous to one’s health, the deformity can certainly complicate one’s life and ability to perform even simple tasks.  Although there is no cure for Dupuytren’s contracture, treatment options are available at the Caringbah office location of Southern Hand & Wrist, serving the Sutherland Shire, South-Eastern Sydney, and other parts of New South WalesDr. Jai Sungaran can help sufferers find relief from their symptoms and improve their quality of life.

If you suffer from the symptoms of Dupuytren’s contracture, we urge you to schedule your initial consultation with Dr. Sungaran by contacting Southern Hand & Wrist, serving communities throughout the Sutherland Shire, today.

What causes Dupuytren’s contracture?

The cause of Dupuytren’s contracture is entirely unknown.  There is no evidence to suggest that the condition is caused or in any way worsened by repetitive hand motions or overuse of the hand, nor is the condition caused by injury or trauma.  What is known is that the condition:

  • Tends to be hereditary.
  • Is most common among people of Northern European (English, Irish, Scottish, French, Dutch) and Scandinavian (Finnish, Norwegian, Danish, Swedish) heritage.
  • Has been connected to diabetes and seizure disorders, such as epilepsy.
  • Is more common among men than women.
  • Is more common among those over the age of 50.
  • May be more likely to occur in those who smoke and consume alcohol.

Although Dupuytren’s contracture is not dangerous, it can interfere with such basic tasks as driving, washing dishes, and even buttoning clothing.  Patients can also experience pain at the site of the nodules.

How is Dupuytren’s contracture diagnosed?

Dr. Sungaran is generally able to diagnose Dupuytren’s contracture simply by performing a physical exam.  The presence of nodules on the palms, tough cords of tissue at the base of the fingers, and an inability to flatten the fingers (the ring and pinkie fingers in particular) are usually evidence enough of the condition.  He may perform other tests if he suspects damage to other tissues of the hand or if a patient presents symptoms that are not consistent with Dupuytren’s contracture, such as pain in the fingers.

How is Dupuytren’s contracture treated non-surgically?

For many patients diagnosed with Dupuytren’s contracture, the condition does not really interfere with their everyday lives.  Indeed, some people never experience noticeable contracture of their fingers.  For these patients, routine observation and stretching exercises may be all that are necessary.  While stretching won’t prevent contracture, it can help to keep the fingers supple and strong.

Patients who are experiencing pain at the site of the nodules may benefit from corticosteroid injections.  These injections can help to relieve pain and may also help to slow the progression of the disease in its earliest stages, before the thick cords of tissues have begun to develop.  Unfortunately, corticosteroid injections will not have any effect on the fingers once they have started to contract.

For patients whose fingers have already contracted, enzyme injections directly into a thickened cord of tissue can cause the cord to become loose, possibly even loose enough to straighten the affected fingers.  If not, the fingers can be manipulated in an attempt to break the cord.  Even if this treatment proves successful, however, relapse is a near certainty.

How is Dupuytren’s contracture treated surgically?

Although there is no cure for Dupuytren’s contracture, surgery provides the longest-term solution to the condition.  Dr. Sungaran may recommend surgery as the first course of treatment in advanced cases of Dupuytren’s contracture, such as when the contracture of the affected fingers is greater than 30 degrees or when the contracture has resulted in functional disabilities.

If possible, Dr. Sungaran will perform a procedure called needle aponeurotomy, a minimally invasive procedure in which a small hypodermic needle is used to divide and sever the contracting tissues in the diseased regions of the palm and fingers.  While this technique is not appropriate for all cases of Dupuytren’s contracture, it is the preferred technique when it is feasible.

When needle aponeurotomy is not feasible, Dr. Sungaran will perform:

  • Fasciotomy: During fasciotomy, the thickened cord of tissue is divided through an incision made in the palm.
  • Fasciectomy: During fasciectomy, the thickened cord of tissue is removed, either in part or entirely, through an incision made in the palm.

If necessary, Dr. Sungaran uses a skin graft or Z-plasty flaps to close the surgical wound. It may also be necessary to release joint contractures at the time of surgery to achieve a full correction.

It is important to note that even after surgery for Dupuytren’s contracture, symptoms may recur.  Months of post-surgical physical therapy are necessary to achieving the best possible results.

Learn More about the Treatment of Dupuytren’s Contracture

If you would like to learn more about how Dr. Jai Sungaran can help you find relief from the symptoms of Dupuytren’s contracture, please contact our Sutherland Shire practice, with Caringbah or Sydney Olympic Park clinic locations, today.

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