Blog Post

Dupuytren’s contracture, a genetic disorder that thickens and tightens the tissues in your hand, can make your fingers curl in toward your palm. The condition becomes uncomfortable as it advances, and constantly curled fingers are inconvenient and can truly disrupt your quality of life. 

At Northeast Orthopaedics & Sports Medicine, our experienced team of board-certified, fellowship-trained orthopedic surgeons understands how frustrating it is to struggle with ordinary finger and hand movements when you have Depuytren’s disease. We’re here to help patients overcome the limitations of this condition with a Depuytren’s procedure. 

The most common question many patients ask about treatment for Depuytren’s is “What can I expect from my procedure?” Here’s what to know about our nonsurgical and surgical treatments.

When does Depuytren’s disease require treatment?

Depuytren’s contracture affects more than 10 million Americans today. It starts with early bumps or nodules in the palm of the hand. In the earlier stages, the disease is usually painless. 

But Depuytren’s is a progressive condition. In the later, more advanced stage, the nodules become cords that thicken and tighten so the fingers start curling inward. Up to 40% of people with the disease experience significantly impaired hand function. 

When this happens, it becomes difficult to straighten the fingers fully. This can make ordinary things like buttoning a shirt, brushing your teeth, holding a pen, or opening a door feel frustrating or even impossible. 

That’s why treatment is so important: It can help you reclaim these normal hand movements, with less down time than you might imagine.

Minimally invasive nonsurgical option: Aponeurotomy

An aponeurotomy, or percutaneous needle fasciotomy, is a nonsurgical procedure that treats mild to moderate finger bending caused by Depuytren’s. With this approach, your doctor uses a beveled needle to make tiny punctures in the tightened cord under the skin.

This loosens the cord so your finger can straighten again. Your doctor may also inject steroids as an adjuvant therapy. The steroids work to decrease swelling and improve comfort, while the aponeurotomy works to make movement possible. 

For the right candidates, an aponeurotomy can be a good choice because it avoids incisions, requires just one short office visit, and has a rapid recovery. 

Surgical options: Fasciotomy and Fasciectomy 

Hand surgery may be the right choice when you have moderate to severe Dupuytren’s symptoms.

Fasciotomy

In a fasciotomy, your doctor creates a narrow, limited incision in the palm of the hand. This incision follows the line of the tight cord that draws your finger inward, so it may extend to the base of the affected finger or into the finger depending on your needs. 

Your surgeon locates the Dupuytren cord and carefully separates it from the soft tissue (blood vessels and nerves) surrounding it. Then, they release the cord by creating one or more small, carefully positioned cuts in the cord. These cuts allow the cord to relax, which means patients can usually straighten their finger immediately after the procedure.

Although it requires a longer recovery than aponeurotomy, a fasciotomy can treat more advanced cases than a nonsurgical approach. However, a fasciotomy might not be the right choice for severe, chronic Dupuytren’s disease. That’s where another procedure called fasciectomy may enter the picture.

Fasciectomy

A fasciectomy is the most complex surgery for Dupuytren’s disease. For this procedure, your surgeon creates an incision, often in a zigzag pattern, to expose all of the damaged tissue (the palmar fascia) in the palm. 

With Dupuytren’s contracture, the advanced stage of Dupuytren’s disease, the cords are tight and hardened in place. In this situation, cutting the cords isn’t adequate, so the goal of a fasciectomy is to remove the hardened tissue. In some cases, patients need skin removal, with a skin graft afterward.

Removing the hardened cords and nodules restores balance in the hand. With that unhealthy tissue gone, the hand adapts over time and new healthy tissue forms where needed. After recovery, the fingers can move more freely, and the recurrence rate is low. 

Splints and physical therapy are essential for a smooth recovery, regardless of the procedure you choose.

At Northeast Orthopaedics & Sports Medicine, our premier surgeons emphasize advanced, minimally invasive approaches whenever possible. We’re ready to help you straighten things out, so book an appointment at the office nearest you today. We have convenient locations in San Antonio, Schertz, New Braunfels, and Live Oak, Texas.