From the Guidelines
Dupuytren's contracture is a significant condition that can lead to morbidity and impact quality of life, and patients with this condition should be screened for harmful alcohol consumption as it is a clinical sign suggestive of alcohol-related liver disease (ALD) 1.
Diagnosis and Management
Dupuytren's contracture is characterized by thickened tissue forming under the skin of the palm, causing fingers to bend inward toward the palm. The condition tends to progress slowly and can recur after treatment. It's most common in older men of Northern European descent and has genetic factors.
Treatment Options
Treatment depends on severity but typically begins with observation for mild cases. For moderate cases, needle aponeurotomy (breaking up the tissue with a needle) or collagenase injections (Xiaflex) may be recommended to dissolve the cords. Severe contractures often require surgical fasciectomy to remove the affected tissue.
Importance of Early Intervention
Physical therapy is important after any intervention to maintain hand function. Patients should seek treatment when finger contracture begins to interfere with daily activities or when the hand can no longer lie flat on a surface. While there's no cure, early intervention can help manage symptoms and maintain hand function.
Association with Alcohol-Related Liver Disease
As Dupuytren's contracture is a clinical sign suggestive of ALD, screening for harmful alcohol consumption should be undertaken in patients with this condition 1. This is crucial in reducing the risk of disease progression and occurrence of complications from cirrhosis.
Key Recommendations
- Screening for harmful alcohol consumption should be done in patients with Dupuytren's contracture 1.
- Treatment of Dupuytren's contracture should be individualized based on severity and patient factors.
- Early intervention is essential in managing symptoms and maintaining hand function.
From the Research
Dupuytren's Disease Overview
- Dupuytren's disease is a chronic condition with no cure, and its worldwide prevalence is 8% 2.
- The disease is characterized by the shortening and thickening of the fibrous tissue of the palmar fascia, leading to contracture of the fingers 3.
- Genetic factors account for 80% of the causes of Dupuytren's disease, and other associated factors include diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools 2.
Treatment Options
- Various treatments are available for Dupuytren's disease, including limited fasciectomy, percutaneous needle fasciotomy, collagenase injection, and radiotherapy 4, 2, 5.
- Limited fasciectomy is considered the reference standard, but it has a cumulative risk of complications of 3.6-39.1% and a recurrence rate of 12-73% at 5 years 2.
- Percutaneous needle fasciotomy is a less invasive method with a lower complication rate, but it has a higher recurrence rate, with 85% of patients experiencing recurrence after an average of 2.3 years 2.
- Collagenase injection is a non-surgical treatment option that has been shown to be safe and effective, but its efficacy in patients with recurrent Dupuytren's disease is still being studied 6, 5.
Treatment Outcomes
- A randomized controlled trial comparing surgery, needle fasciotomy, and collagenase injection found similar success rates at 3 months, but surgery had superior success rates at 2 years 6.
- Another study found that collagenase injection was effective in treating recurrent Dupuytren's disease, but its long-term efficacy is still unknown 5.
- The choice of treatment depends on various factors, including the patient's degree of suffering, the severity of the contracture, and the potential risks and benefits of each treatment option 4, 2.