From the Research
Dupuytren's contracture treatment should prioritize needle aponeurotomy as the first line of treatment due to its effectiveness, minimal invasiveness, and lower complication rate compared to other treatment options, as supported by the most recent and highest quality study 1.
Overview of Dupuytren's Contracture
Dupuytren's contracture is a hand condition characterized by the formation of thickened tissue under the skin of the palm, leading to fingers bending inward toward the palm. It typically affects the ring and little fingers and progresses slowly over years. The condition is more common in older adults, especially men of Northern European descent, and has genetic factors. Other risk factors include diabetes, smoking, alcohol consumption, and certain medications.
Treatment Options
Treatment depends on the severity of the condition. For mild cases, observation may be sufficient. As it progresses, treatment options include:
- Needle aponeurotomy (using a needle to break up tissue)
- Collagenase injections (Xiaflex) to dissolve cords
- Surgery (fasciectomy) to remove the thickened tissue Physical therapy is often recommended after any procedure to restore hand function.
Recommendation
The most effective treatment for Dupuytren's contracture is needle aponeurotomy, which has been shown to be a safe and effective procedure with a high patient satisfaction rate and minimal downtime 2. While recurrence rates are higher compared to open fasciectomy and collagenase injections, the benefits of needle aponeurotomy, including its minimal invasiveness and lower complication rate, make it the preferred treatment option. A comprehensive review of the literature supports this recommendation, highlighting the importance of considering the patient's individual needs and the potential risks and benefits of each treatment option 3, 1.
Key Considerations
- The condition often recurs after treatment, so follow-up with a hand specialist is important for long-term management.
- Physical therapy is essential to restore hand function after treatment.
- The treatment approach should be individualized based on the patient's specific needs and the severity of the condition.