What are the treatment options for Dupuytren's Contracture?

Treatment Options for Dupuytren's Contracture

The most effective treatment approach for Dupuytren's contracture depends on disease severity, with needle aponeurotomy and collagenase injections recommended for mild to moderate contractures, while surgical fasciectomy remains the mainstay treatment for extensive contractures due to its more durable results. 1

Treatment Algorithm Based on Disease Stage

Stage 1 (Nodules without contracture)

• Observation is typically recommended
• No surgical intervention needed at this stage 2
• Physical therapy may be considered but has limited evidence for altering disease progression

Stage 2 and Beyond (Developing contractures)

1. Minimally invasive options:

   • Needle aponeurotomy (NA):

     • Ultrasound-guided dry-needle aponeurotomy with lidocaine injections 3
     • Benefits: Minimal downtime, fewer complications
     • Best for: Metacarpophalangeal (MCP) joint contractures, less severe disease

   • Collagenase Clostridium histolyticum (CCH) injections:

     • Enzymatic fasciotomy followed by manipulation
     • Benefits: Outpatient procedure, minimal recovery time
     • Best for: Moderate contractures 4, 5

2. Surgical intervention:

   • Palmar fasciectomy:
     • Gold standard for extensive contractures
     • More durable long-term results
     • Indicated when contractures significantly impact hand function 1, 2
     • Requires longer rehabilitation period

Factors Influencing Treatment Selection

• Severity of contracture: More severe contractures (especially PIP joint involvement) may require surgical intervention
• Patient factors: Age, comorbidities, occupation, and functional demands
• Joint involvement: MCP joint contractures respond better to minimally invasive treatments than PIP joint contractures
• Previous treatments: Recurrent disease may require more aggressive approaches

Adjunctive Therapies

• Physical therapy and splinting:

  • Limited evidence for preventing progression
  • May be beneficial post-intervention to maintain results
  • Daily stretching exercises to maintain joint mobility 6

• Orthoses/splinting:

  • Can be considered for symptom relief (Level 1b evidence, Grade A recommendation) 6
  • Most beneficial after intervention to maintain correction

Emerging Treatments

• Osteopathic manipulative treatment:
  • Case reports suggest benefit when combined with needle aponeurotomy 3
  • Requires further research to establish efficacy

Important Considerations

• Recurrence rates vary by treatment:

  • Needle aponeurotomy: Higher recurrence rates but can be repeated
  • Collagenase injections: Moderate long-term efficacy
  • Surgical fasciectomy: Most durable results but with longer recovery

• Potential complications:

  • Surgical interventions carry risks of nerve injury, infection, and complex regional pain syndrome
  • Minimally invasive approaches have lower complication rates but higher recurrence rates

Follow-up Care

• Regular follow-up is crucial (Level 5 evidence, Grade D recommendation) 6
• Monitor for disease recurrence or progression
• Adjust treatment approach based on disease evolution

The choice of treatment should be guided by the extent of contracture, functional impairment, and patient preferences, with minimally invasive options preferred for milder disease and surgery reserved for more extensive contractures.