Nodules and tightening of the fingers due to Dupuytren’s disease can be managed with surgical and non-surgical techniques.
Dupuytrens disease is a common progressive condition of the hands. Scarring and contraction develop in the layer of the hand just under the skin. This contraction eventually pulls the fingers into flexion, so that you cannot straighten out your hand.
Mild Dupuytrens disease does not need surgery or therapy to prevent its progression. Treatment should be considered when the contraction becomes significant. A guide to this is being unable to flatten your hand on a table. The Dupuytrens scar should then be removed, as the joints in the hand can become permanently damaged if this is left untreated.
Treatment is aimed at either breaking up the scar causing the contracture or cutting it away completely. These treatments are injections or surgery.
Injecting a chemical that can break up the Dupuytrens scar. This chemical dissolves the scar in parts, allowing the fingers to straighten out. The injection is done in the office after a local anaesthetic injection. You then come back to the office after a couple of days for the straightening, which is again done under local anaesthetic. The hand becomes quite bruised and a little sore, but this usually settles quite quickly. Injection treatment has a much quicker recovery than surgery, but the Dupuytrens recurrence rates are higher than that in surgery. This is because the Dupuytrens disease is broken up rather than removed.
Surgery can cut away the troublesome Dupuytrens scar. This is done in hospital, usually as a day surgery case. The fingers will stretch out after the operation. This surgery is close to the skin, and the scar is usually long. This means that the hands can be sore for a while, and wont be able to be back to normal use for some weeks. This prolonged recovery can be worthwhile, as surgery results in the lowest Dupuytrens disease recurrence.
Dr Kotronakis has regular lists at St George, Hurstville, Bondi Junction and St Luke’s private hospitals. Carpal tunnel release can be performed at all these hospitals.