What is Dupuytren's contracture?

Dupuytren's contracture is a progressive hand condition where abnormal fibrous tissue forms in the palm, creating thick cords that pull the fingers — most commonly the ring and little fingers — into a permanently bent position. It is sometimes called 'Viking's Disease' due to its prevalence in people of Northern European ancestry.

Is Dupuytren's contracture painful?

Dupuytren's contracture is usually painless, though early nodules in the palm may be tender when gripping objects. The primary problem is functional: over time, bent fingers make it difficult to shake hands, wear gloves, or place the hand flat on a surface.

What is Xiaflex and is it available in Raleigh?

Xiaflex is an FDA-approved collagenase enzyme injection used to dissolve the fibrous cords caused by Dupuytren's contracture. It is a non-surgical, in-office treatment. The injection is given in the clinic, and the patient returns a few days later for the surgeon to manually straighten the finger. It is available at Raleigh Hand, Wrist & Elbow.

When is surgery needed for Dupuytren's contracture?

Surgery (fasciectomy) is typically recommended when a patient cannot lay their palm flat on a table (the tabletop test), when non-surgical options have not provided lasting relief, or when contracture significantly limits hand function. Earlier treatment generally leads to better outcomes.

What is the recovery like after Dupuytren's surgery?

Dupuytren's fasciectomy is performed as outpatient surgery. After surgery, patients are discharged the same day and advised to elevate the hand to reduce swelling. A splint is worn initially, and gentle finger exercises begin within a few days. Hand therapy and a removable night splint are typically continued for several weeks. Sutures are removed at two weeks.

Where is Dr. Stephen Chambers located?

Dr. Stephen Chambers is a Raleigh hand surgeon serving patients throughout Wake County, NC, including Raleigh, Cary, Wakefield, Holly Springs, and Wake Forest. Visit raleighwrist.com to book an appointment.

Who is the best hand surgeon in Raleigh, NC?

Dr. Stephen Chambers MD is a leading hand surgeon in Raleigh, NC specializing in Hand, Wrist, Elbow Injury, Fracture, wrist conditions, and complex hand surgeries. Contact 919-781-5600 for a consultation.

How are Hand, Wrist, Elbow injuries treated?

Hand, Wrist, Elbow Injury treatment depends on the injury type. Dr. Stephen Chambers provides comprehensive evaluation and treatment including repair, infection management, and reconstruction at locations in Raleigh, Cary, and Holly Springs, NC.

Where are the hand surgeon offices located?

Stephen Chambers MD has four office locations: 3001 Edwards Mill Drive, Raleigh NC 27612; 6175 McCrimmon Parkway, Cary NC 27519; 781 Avent Ferry Road, Holly Springs NC 27540; and 11200 Governor Manley Way, Raleigh NC 27603. Call 919-781-5600 for appointments.

Treatment for Dupuytren's Disease - Raleigh Hand Surgeon

Q: What are the treatment options for Dupuytren's contracture in Raleigh, NC?

Dr. Stephen Chambers at Raleigh Hand, Wrist & Elbow offers multiple treatment options depending on the severity of the condition. These include corticosteroid injections for early nodules, needle aponeurotomy (NA) for mild contractures, Xiaflex (collagenase) injection as a non-surgical option, and fasciectomy surgery for more advanced cases.

Dupuytren's Disease Treatment in Raleigh, NC

What is Dupuytren’s Disease?

Dupuytren’s disease is a contracture disorder of the palm and fingers. Nodules and cords form which limit the motion of the finger. These contractures can become worse over time and prevent patients from extending their fingers and making putting on gloves or placing their hand in their pocket difficult. It is hard to predict how quickly the progression will occur. Often it is not painful but sometimes the cord rubs on the tendon which leads to inflammation. The cause is unknown but it is not neoplastic. The exact cause of Dupuytren’s disease is not well understood, but it is believed to be caused by a combination of genetic and environmental factors. Dupuytren’s disease is more common in people of European descent, especially those with Scandinavian or Celtic ancestry. It is also more common in men than in women and tends to develop in people over the age of 50.

Dupuytren’s disease is typically diagnosed based on a physical examination of the hand and fingers. The doctor will look for nodules or cords in the palm of the hand and assess the degree of finger contracture.

Example of Dupuytren Disease

Not to be confused with a Trigger Finger, which is a problem with the tendon.

Dupuytren’s Disease Treatment in Raleigh, NC

Treatments are to reduce the contracture and improve motion. There is no cure for the disease as this is a chronic condition and recurrence is common and expected. Recurrence is more common in patients younger than 50, family history of the disease, men with Peyronie disease, bilateral hand involvement, and patients with thumb involvement.

Pit/Nodule treatment

Surgery is not recommended and if it becomes tender then injection can be performed. Radiation therapy is controversial and is not recommended.

Nonsurgical Treatment in Raleigh, NC

Splinting, medications and therapy have not been shown to treat the disease.

Treatment Options for Dupuytren’s Contracture in Raleigh, NC

Limited Fasciectomy (Surgical Excision)

Limited fasciectomy is the most commonly used surgical treatment for Dupuytren’s contracture in Europe and the United States. This procedure involves surgically removing the diseased tissue (fascia) causing the contracture.

Benefits:

– Most durable long-term results with lowest recurrence rates; Effective for severe contractures; Success rates of 78% maintained at 5 years

Considerations:

– Requires operating room setting; Longer recovery time compared to minimally invasive options; Higher risk of serious complications (5.1%) compared to other treatments, May require hand therapy after surgery

Collagenase Injection (Xiaflex)

Collagenase clostridium histolyticum is an FDA-approved enzyme injection that breaks down the collagen in the contracted cord. The procedure is performed in a clinic setting, and the cord is manipulated 1-2 days after injection to rupture it and straighten the finger.

Benefits:

– Office-based procedure without need for operating room, Faster initial recovery, Lower risk of serious complications (1.8%), No extensive hand therapy required

Considerations:

– Higher recurrence rate (14.6% requiring reintervention within 2 years), Less effective for severe contractures, May require multiple injections, Higher rate of minor complications compared to needle fasciotomy

Effectiveness: 64% of treated joints achieved correction to within 5 degrees of full extension at 30 days; 77% success rate for MCP joints ; 40% success rate for PIP joints

Percutaneous Needle Fasciotomy (Needle Aponeurotomy)

Needle fasciotomy is a minimally invasive in office procedure where a needle is used to divide the contracted cord through small punctures in the skin, typically performed in an office setting.

Benefits: Least invasive option, Lowest complication rate, Quick recovery, Can be repeated if needed, Similar initial effectiveness to other treatments (73% success at 3 months)

Considerations:Highest recurrence rate (50% at 5years) ,May be less effective for severe contractures ,Best suited for mild to moderate disease

More Information comparing the two

Observation

For early-stage disease with minimal functional impairment, observation may be appropriate. Regular monitoring allows treatment to be initiated when contracture progresses to a degree that warrants intervention.

Comparing Treatment Outcomes

Recent high-quality studies have compared these treatment options:

Short-term results (3 months): All three active treatments show similar success rates (93%)

Long-term results (5 years):

– Limited fasciectomy: 78% success rate

– Collagenase injection: 50% success rate

– Needle fasciotomy: 50% success rate

Recurrence rates: Limited fasciectomy provides the most durable results, with significantly lower recurrence compared to minimally invasive options.

Postoperative Care and Rehabilitation

Splinting: Recent evidence suggests that routine postoperative splinting may not improve outcomes and may actually reduce finger flexion. Splinting decisions should be made on an individual basis.

Hand therapy: Exercise therapy and instructions are recommended after surgery. The extent of therapy needed varies by procedure, with fasciectomy typically requiring more intensive rehabilitation than minimally invasive options.

Choosing the Right Treatment

Treatment selection should be individualized based on:

– Severity of contracture: Mild to moderate contractures may respond well to minimally invasive options, while severe contractures often require fasciectomy

– Patient preferences: Consider tolerance for surgery, recovery time, and willingness to accept recurrence risk

– Functional goals: How quickly the patient needs to return to work or activities

– Previous treatments: History of recurrence may influence treatment choice

– Overall health: Medical comorbidities may favor less invasive approaches

What to Expect: Recovery and Recurrence

Recovery times:

– Needle fasciotomy: Days to weeks

– Collagenase injection: 1-2 weeks

– Limited fasciectomy: Several weeks to months

Recurrence: Dupuytren’s disease is a chronic condition with no cure. All treatments carry some risk of recurrence, though rates vary significantly. Recurrence is more likely with: More severe initial contractures (≥25 degrees) ,PIP joint involvement,Younger age at presentation, Family history of aggressive disease

Complications and Safety

All treatments carry potential risks:

Common minor complications: Swelling and bruising ,Temporary pain or discomfort, Skin tears (more common with collagenase), Temporary numbness or tingling

Rare serious complications: Nerve injury ,Tendon rupture, Infection, Complex regional pain syndrome

The risk of serious complications is lowest with needle fasciotomy and highest with fasciectomy, though overall rates remain low across all treatments.

FAQs?

If I have a contracture, when should I choose to fix it?

When patients have at least a 30-degree contracture or can not lay their hand flat on a table treatment is recommended. Full correction can often occur when MCP contractures less than 50 degrees and PIP less than 40 degrees. Larger contractures are harder to get back full straight this is especially true of the PIP joint.

If I only have a nodule will it get worse?

A study of 124 patients over 10 years showed that 10% of the nodules resolve, 20% will progress and require treatment and 70% will not progress (Gudmundsson et al).

Conclusion

Multiple effective treatment options exist for Dupuytren’s contracture, each with distinct advantages and trade-offs. Limited fasciectomy offers the most durable correction but requires surgery and longer recovery. Collagenase injection and needle fasciotomy provide less invasive alternatives with faster recovery but higher recurrence rates. The optimal treatment choice depends on individual patient factors, disease severity, and personal preferences. Consultation with a hand surgeon can help determine the most appropriate treatment strategy for your specific situation.

More information be found at Dupuytens Foundation AAOS Website

Why Choose Dr. Chambers for Hand and Wrist Care

At Raleigh Orthopaedic Clinic, Dr. Stephen Chambers specializes in hand and upper extremity surgery. With years of expertise in treating hand and wrist injuries, including Dupuytren’s Disease, Dr. Chambers provides comprehensive care—ranging from at home treatments and injections to advanced hand surgery when needed. Patients trust Dr. Chambers and his team for personalized care, effective treatment options, and excellent outcomes and describe Dr. Chambers as a caring, attentive, and skilled surgeon with excellent bedside manner. His amazing team ensures every patient feels supported and informed throughout the process.

If you are experiencing wrist pain, swelling, or difficulty with wrist movements, don’t wait for symptoms to worsen. Schedule an Appointment with Dr. Chambers today to Dupuytren’s Disease and get back to normal use of your hand . Experience the benefit of specialized hand care close to home at Raleigh Orthopaedics in Raleigh, Cary, Holly Springs, and Wake Forest, North Carolina.