Dupuytren's Disease. Diagnostics & Therapy
The change to the hand can usually be treated quite easily.
To the experienced doctor, Dupuytren's Disease is usually immediately recognisable: the characteristic contractures of the fingers, combined with tests for finger mobility, hereditary factors and palpation of the hand, are rapid ways to identify the disease. There are various methods for easily treating the condition today.
Whilst surgery for Dupuytren's contracture was often inevitable in the past, doctors today have a range of conservative treatments at their fingertips. The misshapen cords of connective tissue in the hand can be released by the use of medication or fine needles without the need for surgery.
Diagnostics, therapy & treatment of Dupuytren's Disease.
Diagnostics. How Dupuytren's Disease is recognized
How is Dupuytren's Disease diagnosed?
An experienced doctor can diagnose the disease visually, and obtain additional information by taking the medical history and examining the patient.
- Clarifying the family history
- Presence of diseases such as diabetes mellitus (diabetes), epilepsy, liver disease, narrowing of a nerve (nerve compression)
- Examination of the hand and fingers for hardening, checking for instability of the skin
- Functional testing, i.e. whether the finger can be moved (closing, stretching, spreading the fist)
- Sensitivity test (any loss of sensation?)
- Checking the circulation of the blood
Differential diagnosis in Dupuytren's Disease.
As a differential diagnosis, conditions such as shrivelled and hardened scars (cicatricial contraction), arthritis of the finger joints, congenital curvatures of the fingers (camptodactyly), arterial stenosis in the anular ligament of the fingers, known colloquially as 'trigger finger' or 'finger snap', should be taken into consideration.
Conservative treatment. Therapy for Dupuytren's Disease
New therapies as alternatives to surgery.
For a long time, patients with Dupuytren's Disease could only be treated with complex surgical procedures. Whilst they promise lasting, long-term improvements, they are associated with a longer phase of recovery and immobilisation of the hand in question.
Two ambulant procedures are in fact now available: Collagenase treatment (enzyme therapy) and needle fasciotomy. They offer promising alternatives to surgery.
Alternative I: Collagenase or enzyme treatment.
Treatment with medication, in the form of collagenase or enzymes, is an entirely new concept for patients with Dupuytren's disease. This method was only approved for use in Germany in May 2011. Since our hand surgeons had already been partly involved in the testing phase in Sweden, we now have more than five years' experience in this procedure.
The procedure is as follows: The enzyme collagenase is injected directly into the thickened cord of connective tissuee in the hand, causing it to weaken. „Imagine you have a block of ice in your hand which is now made to melt“, hand surgeon Dr Bernhard Lukas explains. The injection can be administered by an experienced specialist during an outpatient procedure. Then it's just a matter of waiting.
After 24 hours the cord will have weakened to the extent that the hand surgeon can snap it by purposely over-extending the palm of the hand. „Our patients come to us two days in a row, each time for a short treatment session; they do not need a general anaesthetic and there are no open wounds“, says Dr Lukas, to explain the advantage of such therapy. The hand is placed in a splint for one day, and is fully functional again the following day. The cord of connective tissue must already be palpably swollen, however.
Alternative II: PNF or needle fasciotomy.
For some years now, Dupuytren's disease has been treated on an outpatient basis under local anaesthetic, by piercing the cord of connective tissue with a fine needle inserted through the skin. It is weakened in the same way as with enzyme treatment, and tension can also cause it to snap. This is an outpatient procedure referred to as PNF, or percutaneous needle fasciotomy.
„According to hand surgeon Dr Lukas, this method can produce relatively good results, especially when treating a curvature of the wrist“. The cord of connective tissue needs to be palpably swollen, however, „otherwise I'm not able to pierce it directly. The procedure would then be too risky.“
Surgery. Medical intervention in Dupuytren's Disease
Surgery has not been replaced by new methods.
If the cords of connective tissue are not palpable, such as in the early stages of the condition or the very advanced stages as the hands become very bent (more than 90 degrees), surgery is still the best and most reliable option. In addition, surgery offers better long-term results despite requiring a hospital stay and longer recovery period. After surgery, it takes about six to eight weeks until the hand can function once more.
„Conservative treatment offers faster and easier relief – though the patient is likely to return to us sooner for a follow-up procedure“, hand surgeon Dr Lukas explains when describing the advantages and disadvantages. „Half of the patients undergoing outpatient therapy will experience problems again after about three years. Hence an individual decision must be made as to which treatment method is at the time most likely to improve the patient's quality of life.“
Follow-up: Regular exercises.
Following surgery, the hand should be left to rest for a certain period of time. For this reason, our patients are fitted with a customised splint which must be worn day and night for the first two weeks, and then only at night for a further six months.
The splint can be removed just one or two days after the procedure in order to exercise, thereby mobilising the hand and fingers as soon as possible. Our therapists will then give the patient exercises to continue with at home so as to optimise the movements of the hand.