Dupuytren's Contracture

A common but easily treated problem where the fingers draw up into the hand. Non-surgical treatment usually works, but if surgery is needed, it is very effective in correcting the problem!

What is it?
Dupuytren's contracture is a condition where the tough layer in the palm, just under the skin, contracts and draws the fingers into the hand. It is not usually painful, but can cause significant problems with day-to-day use of the hands.

What causes it?
No-one is quite sure what exactly causes it, but there is over-stimulation of cells called myofibroblasts that just cause that layer under the skin to tighten up. We do know it tends to run in families, and men are more commonly affected than women.

Will it get worse?
This problem generally progresses with time and does tend to draw the fingers further into the palm if left untreated. It will not go away on its own.

What is the treatment?
Methods like splinting and pills and therapy are not effective for this condition. There is a new injectable medicine that Dr. Metzger specializes in called Xiaflex, which is very effective for some types of Dupuytrens. It avoids the need for surgery as much as 60% of the time! If surgery is needed, it is done as an outpatient with no hospital stay, and is effective in correcting the problem.

Do I need surgery?
If the injection doesn't work, and you are having problems using your hand because of the inability to straighten the finger or fingers, then surgery is very helpful.

Tell me about the surgery
If injections and medicines don't work, surgery may be recommended. It is an outpatient surgery, meaning you go home the same day as surgery. It is done with complete anesthesia for patient comfort. It takes about 30-45 minutes, and is done through incision which are normally barely visible once healed. After the surgeon incises the skin, the diseased part of the tough layer under the skin (palmar aponeurosis) is removed, allowing the fingers to straighten. More than 95% of patients have improvement of the problem after surgery, and many are able to completely straighten the fingers. This condition can return after successful surgery, but often does not.

Is surgery safe?
Your surgeon will discuss the risks with you, but it is a very safe and effective procedure.

How long would I be out of my job after surgery?
You will be sent home with a bandage and splint on your hand. It will be left on for a week and then there is a return to the office where the stitches are removed, and gentle exercises to start regaining motion are begun. The splint is worn for a month, then regaining full use of the hand occurs over another month or two.

Article in Newspaper about Dupuytren's
Here's an article from The Sun Chronicle that gives a real-life look at Dupuytren's