Should I have surgery for Dupuytren's disease?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Surgery may be recommended for severe cases of Dupuytren's disease in which the tissue beneath the skin in the palm thickens to the point that your hand movement is limited. Consider the following when making your treatment decision:
- Before considering surgery, you might try nonsurgical treatment including physical or occupational therapy and home stretching exercises.
- You may want to consider surgery if your finger or fingers are bent to the palm and cannot be straightened (contracture).
- You may not want to consider surgery if you are able to move your fingers and do daily activities.
- You may need to have surgery again if the disease recurs and you lose mobility in your hands.
Medical Information
What is Dupuytren's disease?
Dupuytren's disease is an abnormal thickening of tissue beneath the skin in the palm of the hand. It occasionally occurs in the soles of the feet. This condition usually progresses very slowly and may never require treatment. But for some, Dupuytren's disease may eventually cause the fingers to bend so that they cannot be straightened (contracture).
Dupuytren's disease usually does not cause pain. The first noticeable symptom often is a small lump (nodule) felt in the palm, usually near the base of the fingers. A fibrous, ropelike cord may gradually develop in the palm tissue (fascia). The cord pulls the finger toward the palm (Dupuytren's contracture). Eventually you will not be able to flatten your palm on an even surface, such as a table.
What happens in Dupuytren's disease?
When it is severe, Dupuytren's contracture can make everyday activities—such as picking up items, putting on gloves, or washing hands—difficult or impossible.
What are the nonsurgical treatments for Dupuytren's disease?
In mild cases, regular stretching of the involved fingers may be enough to maintain your hand mobility. Twice-daily sessions of massaging the hand and then gently stretching your fingers back relieves tightness and helps keep the fingers flexible. For some people with mild disease, hand function may be maintained with physical therapy and range-of-motion exercises.
Injections of lidocaine or corticosteroids or both may provide some temporary relief from your symptoms. Other treatments that may provide some relief include splinting.
What are the surgical options for Dupuytren's disease?
Surgery for Dupuytren's disease may relieve severe cases of contracture but will not cure the disease. The most common surgery done for Dupuytren's disease is removal of the abnormally thick and fibrous tissue (fasciectomy). If your palm skin has become stuck (adhered) to the abnormal tissue, the skin may be removed along with the tissue.
Another surgical procedure done in some cases of Dupuytren's disease is fasciotomy, in which the cords of fiber in the palm are divided through small incisions. This procedure is usually reserved for people who, because of general health, are not good candidates for fasciectomy or who have recurrent disease.1
Surgery usually provides relief from contracture and restores mobility in the fingers, but the condition may return.2
Delaying surgery until you have a severe contracture of the fingers makes surgery and recovery more difficult.
What are the possible complications from surgery for Dupuytren's disease?
Complications are common during surgery for Dupuytren's disease. They occur in about 1 in 5 cases.3 Complications can include:
- Delayed wound healing. This is the most common complication and it is usually mild.
- Infection of the wound.
- Stiffness or contracture, with the fingers still being curled.
- Nerve injury.
- Loss of circulation in the fingers.
- Collection of blood or blood clots in the tissues (hematoma).
- Damage to the skin, which results from trying to surgically separate the skin from the diseased tissue (palmar fascia).
- Reflex sympathetic dystrophy.
Surgery usually improves but may not completely restore hand function. Even with successful surgery, thickened palm tissue may develop again in the same place or in a new area of the hands. Reoperation may be necessary to maintain hand function.
If surgery is done, what follow-up exercises and treatment might be required?
After surgery, the disease may recur in the same area or may appear in a new location. But the outcome may be better if you routinely do finger exercises and use splints as instructed by your health professional.
A physical or occupational therapist can teach you how to do exercises to gently move your finger joints through their normal range of motion. These exercises help prevent joint stiffness. Range-of-motion exercises do not include motions that stress or overextend the joint.
Splints may be used after surgery for about 8 to 10 weeks to help restore hand function and prevent symptoms of Dupuytren's disease from recurring. Splints support your palm and help straighten your fingers during the healing process. In some cases, splints are worn only at night, but in others they are worn at all times, except when the wound needs cleaning or during finger exercises. Your health professional will help you learn how and when you wear the splint during recovery.
If you need more information, see the topic Dupuytren's Disease.
Your Information
Your choices are:
- Have surgery to relieve symptoms of Dupuytren's disease.
- Do not have surgery to relieve symptoms of Dupuytren's disease.
The decision about whether to have surgery takes into account your personal feelings and the medical facts.
Deciding about surgery for Dupuytren's disease Reasons to have surgery for Dupuytren's disease Reasons not to have surgery for Dupuytren's disease
- You have been doing finger exercises regularly, but your fingers are increasingly bent to the palm and incapable of flattening.
- You have pain from nodules.
- You are unable to pick up things, put on gloves, or do other everyday activities with your hand(s).
- You accept that the disease may recur in a few years and repeat surgery may be necessary.
- Delaying surgery until you have a severe contracture of the fingers makes surgery and recovery more difficult.
Are there other reasons you might want to have surgery?
- You are able to move your fingers and do daily activities.
- You have had surgery at least once to correct severe contracture of your fingers, but the condition returned within a few years, and you do not want to have surgery again.
- Complications from surgery can include nerve injury and loss of mobility.
- Surgery may improve but not completely restore hand function.
Are there other reasons you might not want to have surgery?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for Dupuytren's disease. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
My fingers are rigidly bent, and it's getting harder for me to even wash my hands. Yes No Unsure I realize that after surgery I still may not be able to flatten my hand on a table. Yes No Unsure My physical therapist has taught me how to exercise my fingers every day, and it seems to be helping. Yes No NA* I understand that there's a chance my bent finger condition will return after surgery. Yes No Unsure The pain in my hand is affecting my quality of life. Yes No Unsure I understand the possible complications from surgery. Yes No Unsure I am still fairly young, and I don't like the idea of having this surgery every few years. Yes No NA I don't want to get as bad as my dad. By the time he was 80, he couldn't pick up anything. Yes No NA Whatever it takes to let me use my hands again is worth it. Yes No NA *NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for Dupuytren's disease.
Check the box below that represents your overall impression about your decision.
Leaning toward having surgery
Leaning toward NOT having surgery
Return to the topic Dupuytren's Disease.
| Author: | Shannon Erstad, MBA/MPH | Last Updated: March 31, 2008 |
| Medical Review: | William M. Green, MD - Emergency Medicine David Pichora, MD, FRCSC - Orthopedic Surgery | |
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