Dupuytrens disease is a thickening (chord) in the palmar fascia which connects the skin of the hand to the underlying support structures, through which all the tendons, arteries and nerves pass. It can cause painful lumps in the hand but more commonly causes the fingers to bend in painlessly, which can affect function. It is more common in men and is linked to certain medical conditions and has a strong family history.
Anything that disrupts the chord will lead to dramatic improvements in finger position. The simplest intervention is disruption of the chord by physical manipulation with/without a needle that causes the chord to stretch or rupture. This can be facilitated by an injection of an enzyme (Xiapex) 24 hours prior to the procedure. Small procedures can be performed under local anaesthetic which are aimed at breaking up the continuity of the chord by partially removing it. Complete removal can also be performed but this usually requires a general anaesthetic and recovery time is longer.
If the chord is disrupted but not excised, symptoms often recur, although the timescale can be lengthy enough for this to be an acceptable compromise. Removing the chord corrects the problem long term with only a small chance of recurrence.
There is a small theoretical risk of an allergic reaction to the enzyme injection, if a person has not had these injections before. The injection sites occasionally bruise and can swell. Infection is a small risk and like with any injection would be treated with antibiotics. When injecting around the tendons, infection may require an emergency operation, but this is extremely rare. Surgical removal leaves scars on the hand, which may be sensitive, but these usually heal very well. The chords often wrap around the nerves and arteries in the hand and these can be bruised temporarily or their function (rarely) permanently disrupted. Like with all other surgery, bleeding is also a theoretical risk. Tender scar tissue occasionally takes a few months to settle down with massage. The condition rarely recurs.
The success rates for single chord release are very good especially around the larger joints. If the finger joints are affected, then releasing the joints is often also necessary to improve the outcome.
From £500 for needle fasciotomies (disruption of the cord)
From £1,000 for Xiapex enzyme injections (enzyme injection)
From £1,200 for limited fasciotomies (partial chord removal)
From £3,000 for complete fascectomies (total chord removal)
Following any injections or surgery on the hand, swelling and discomfort is inevitable. Elevation of the affected arm and non-steroidal anti-inflammatory medication helps. Early immobilisation for 48 hours helps recovery but must be followed by appropriately gauged mobilisation. Simple pain relief (paracetamol and/or ibuprofen) taken one hour before hand therapy rehabilitation allows more exercises to be undertaken. Desensitisation with moisturiser and massage helps scars to soften and become less painful.
- Surgery duration: 30 minutes-1 hour
- Type of anaesthesia: Local or general anaesthetic
- Time in hospital: Day case
- Time off work: 2 weeks
- Recovery time: 4-6 weeks
- First follow up appointment: 1 week
- Total number of follow up appointments: 3
- Pain management: Simple pain relief (paracetamol and/or ibuprofen)
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