 contracture causes your finger to bend more and more, you will lose the ability to completely straighten out the affected finger. How much of the ability to straighten out your finger you have lost is also measured in degrees.
Measurements taken at later follow-up visits will tell how well treatments are working or how fast the disorder is progressing. The progression of the disorder is unpredictable. Some patients have no problems for years, and then suddenly nodules will begin to grow and their finger will begin to contract.
The tabletop test may also be done. The tabletop test will show if you can flatten your palm and fingers on a flat surface. You can follow the progression of the disorder by doing the tabletop test yourself at relatively regular intervals. Put your hand flat on a table and if you can see sunlight between your hand and the table, it's time to start to consider treatment for the condition. Your doctor will tell you what to look for and when you should return for a follow-up visit.
What can be done for the condition?
There are two types of treatment for Dupuytren's contracture: surgical and nonsurgical. The best course of treatment is determined by how far the contractures have advanced. Palmar Fascia Removal (palmar fasciectomy) or release of the diseased cords still remains the “gold standard” of care for advanced Dupuytren's contracture.
Bracing and stretching of the fingers alone has not been proven to help in the long term progression of this condition.
Nonsurgical and surgical treatments are to treat the contracture itself. This does not cure the disease. Dupuytren's disease continues to slowly form the bands although it may be years before the contracture presents itself again.
The nodules of Dupuytren's contracture are almost always limited to the hand. If you receive regular examinations, you will know when to proceed with the next treatment step. Dupuytren's contracture is a progressive disease, early treatment, determined by the stage of the disease, is important to release the contracture and to prevent disability in your hand. Treatment is determined based on the severity of the contracture.
Ongoing research of this condition has resulted a less invasive method of treatment called an enzymatic fasciotomy, if only the MCP joint is contracted, and there are only one or two cords involved, this procedure may be possible. It may eventually replace surgery. Until then, surgical release of the cords will likely remain the gold standard.
The U.S. Food and Drug Administration (FDA) recently approved a new injectable drug (Xiaflex) for nonsurgical treatment of this problem. By injecting an enzyme directly into the cords formed by the disease, the tissue dissolves and starts to weaken, most often he/she is able to break apart the cord himself/herself.
Generally patients return within 24 hours for recheck. If the cord hasn't broken apart, your physician may have to numb the finger and then stretch the finger to break apart the cord to regain full motion of the finger. That sounds dramatic -- it's not! The treatment is safe and effective. But further study is needed to assess the long-term effects, especially recurrence rates.
There are a few possible (minor) side effects but very few major or long-term complications with this new treatment. During the control trials conducted with patients, most people had a local skin reaction (swelling, redness, skin tears, itching or stinging) where the injection went into the skin. A small number of more serious problems developed in a few patients including skin infection, tendon rupture, finger deformity, complex regional pain syndrome (pain and stiffness), and hives that had to be treated with medication.
Early studies show a good success rate (77 per cent) in reducing MCP contractures using this injection treatment. Almost all of the patients (92 per cent) were able to straighten the MCP joints with less than a 30-degree flexion contracture. Results were not quite as good for the PIP joints. Less than half (44 per cent) of the patients with PIP contractures