Treatment Guidelines for Dupuytren Contractures
For Dupuytren contractures, begin with daily static stretching exercises and consider resting splints for mild cases, progressing to surgical release (fasciectomy) for severe established contractures that fail conservative management. 1
Conservative Management (First-Line for Mild Contractures)
Stretching Protocol
- Perform daily static stretching exercises when pain and stiffness are minimal (typically before bedtime) 1, 2
- Apply superficial moist heat before exercises to improve tissue extensibility 1, 2
- Hold the terminal stretch position for 10-30 seconds, then slowly return to rest position 1, 2
- Repeat this sequence multiple times during each session 2
Orthotic Support
- Use resting hand/wrist splints in combination with regular stretching exercises 1
- Ensure splints provide adequate support without causing excessive pressure 2
- Coordinate splint use with medical specialists to avoid contraindications such as compromised circulation 2
Important caveat: Distinguish Dupuytren contracture from neurologically-based contractures, which present differently and require alternative management 1. In patients with liver disease, Dupuytren contracture may suggest alcoholic etiology 1.
Surgical Management (For Severe or Refractory Cases)
Indications for Surgery
- Severe established contractures that do not respond to conservative measures 1
- Contractures causing significant functional impairment 3
- Progressive disease despite adequate conservative treatment 4
Surgical Options
Surgical release (fasciectomy) is the definitive treatment with moderate evidence supporting its effectiveness 1. Recent evidence from 2024 indicates that surgical palmar fasciectomy remains the mainstay treatment for extensive contractures with durable results 3.
The specific surgical technique should be selected based on contracture severity:
- Segmental fasciectomy through multiple small transverse incisions for less extensive disease, which allows excellent correction with rapid return of finger flexion 5
- Selective fasciectomy for established contractures, with various wound closure options including tissue rearrangement or full-thickness skin grafting 6
Expected Surgical Outcomes
- Metacarpophalangeal joint contracture typically improves from approximately 50-57° to 0-2° 5, 6
- Proximal interphalangeal joint contracture improves from approximately 23-58° to 4-10° 5, 6
- Patient satisfaction rates of excellent or good in over 90% of cases 5
Minimally Invasive Alternatives
For patients seeking less invasive options, consider:
- Collagenase injection for moderate contractures, which provides satisfactory results with moderate long-term efficacy 3
- Needle aponeurotomy for selected cases, particularly when combined with appropriate post-procedure management 7, 3
Critical consideration: While minimally invasive techniques offer shorter recovery times and less postoperative pain, they have higher recurrence rates compared to surgical fasciectomy 4, 3. A shared decision-making process using evidence-based medicine should guide treatment selection 4.
Treatment Algorithm
Mild contractures without functional impairment: Daily stretching exercises with moist heat application and resting splints 1, 2
Moderate contractures with some functional limitation: Continue conservative management for 3-6 months; if no improvement, consider minimally invasive options (collagenase injection or needle aponeurotomy) 3
Severe contractures or failed conservative/minimally invasive treatment: Proceed to surgical fasciectomy 1, 3
Post-treatment (all modalities): Maintain stretching exercises and appropriate positioning to prevent recurrence 2
Common pitfall to avoid: Do not prolong conservative management indefinitely in patients with progressive severe contractures, as this delays definitive treatment and may worsen functional outcomes 1. Conversely, avoid rushing to surgery in mild cases that may respond to conservative measures 1, 2.