It is thought to be a hereditary disease, which means it is inherited from the family, but the exact cause is unknown. Dupuytren's contracture may be associated with cigarette smoking, epilepsy, diabetes, and alcoholism, and usually presents in middle age.
The ring finger is the most commonly affected finger. The little finger is the second most commonly affected finger. One, two, or more fingers may be affected. Men are affected more often than women.
Surgical resection of the diseased tissue has been the standard of care until recently, and is associated with the lowest incidence of recurrence. In fact--it is very difficult if not impossible to "cure" the disease, so some degree of recurrence risk will always exist.
Once a contracture approaches 30 degrees at the MP joint and 15 degrees at the PIP joint, surgery is recommended. Although a select number of hand surgeons around the country have started to offer percutaneous tenotomy as a less invasive alternative to traditional open techniques, the latter remains the most time-honored option.
A minimally invasive technique that some surgeons perform is called needle aponeurotomy; I do not perform this procedure but have read favorable reports. For my patients, I prefer Xiaflex injection as the risk of nerve injury is much lower.
This relatively new noninvasive treatment--injection of an enzyme, "Collagenase", is my most typical recommendation nowadays---for both MP and PIP joint contracture. This has been evaluated in clinical trials and is be safe and efficacious. Below you may read an outcome study from 2010 which shows good results at both the MP and PIP joints compared to placebo. In 2013 the report below detailed recommendations for postoperative splinting and therapy to improve the results following injection/manipulation of more severe PIP joint contractures.
The value proposition of this option is much quicker recovery, and it does not burn the bridge of surgery if it is not effective. Further, manipulation can be performed anytime between 1 day and 7 days after xiaflex injection, as indicated in the 2014 report below; originally it was recommended that manipulation be performed at 48 hours, regardless of whether this time interval might be inconvenient for a given patient.
See the link below for information from the Company which distributes the Clostridial collagenase enzyme.
