HandDupytren’s contracture is a genetic disorder in which the fascia of your hand contracts so that you can’t extend your fingers. What is fascia? When you order a piece of meat, the tough grisel around the meat is fascia.
Dupytren’s contracture occurs in people of Scandinavian (viking) ancestry. Now, the vikings got around back then, so their genes can show up in people that don’t realize that they have some vikings in their family tree.
Dupytren’s contracture starts as a nodule in your hand. This nodule may be tender. Over time, the nodule grows and becomes a rope-like ‘cord’ that progressively pulls your finger closed. The rate of progression is genetically determined, but trauma can accelerate it. It’s not affected by work. There’s really nothing you can do to slow it down; stretching is not effective.
Until there is a contracture (inability to extend) your fingers you don’t want to surgically remove the immature disease, as that may speed up the disease’s progression (possibly because your body views surgery as a minor trauma). The time to have it excised is when your metacarpophalangal joint (MPJ) – the big knuckle where your finger attaches to your hand – loses 30 degrees of extension, or your proximal phalangeal joint (PIJ) – the middle knuckle of your finger – becomes noticeably involved.
Surgery is usually very effective. There are other treatments coming, but they are not FDA approved as of yet, and it’s unclear what their long-term effectiveness will be. Surgical excision usually cures the operated finger, and recurrence is very uncommon. Of course, your genes may cause the contracture to occur in a different area, but there’s not too much that can be done about your genetics now.
In my opinion, the key to avoiding significant pain, stiffness and complications with surgery is to leave part of the wound open. While this may look ‘gross’ for 3-4 weeks until it heals, it allows the swelling to escape, decreasing pain, stiffness and other problems. Once the wound heals in 3-4 weeks, the scar will look no different than if it was sutured shut.
After surgery you’ll be splinted for one week. Then a hand therapist will make you a custom splint. Wear the splint during the day for the next 3 weeks. Take it off 6 times a day for an exericise session. Each session consists of making a fist 6 times and holding each fist for 6 seconds. Use your other hand to help.
After 4 weeks following the surgery (one week in the surgical dressing + 3 weeks in the splint), you no longer need to wear a splint during the day. But it’s a very good idea to continue to wear it at night. The longer you wear your splint at night, the less chance of a recurrence you’ll have. I recommend you wear the splint at night for 6 months.
Most people are very satisfied by their surgical outcomes. The MPJ (big knuckle) contracture usually resolves very nicely. The PIJ contracture (middle joint of the finger) may not fully correct; if this joint is badly contracted, it may only improve 50%. That’s why it’s important to have surgery once the PIJ is noticeably contracted. If the residual contracture is a problem there are other techniques that can be performed to straighten the finger out, but the motion regained after surgery usually makes the hand functional enough that nothing else needs to be done.
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