If you are considering a contracture release or have an operation planned, it is important to know all you can about it. This includes:
- why you need this operation
- what it will be like
- how it will affect you
- what risks are involved
- any alternatives.
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
What is the problem?
You cannot straighten one or more of your fingers. This is because you have developed a Dupuytren's contracture. This is a thickening of the fascia in your hand. It is a common condition in adults. Both Ronald Reagan and Margaret Thatcher had operations for it!
What is the fascia?
The fascia of your palm is a layer of tissue beneath the skin but above the tendons. Its job is to stabilise the skin of your palm and fingers so that it does not move around.
What has gone wrong?
You do not have a problem with your tendons. The cord that you can feel in your palm and fingers is not a tendon but a band of abnormal fascia. This band prevents you fully straightening your finger. Most people develop it for no obvious reason. It can run in families. Sometimes an injury to your hand can make you develop a contracture if you have a tendency to develop Dupuytren’s disease.
The aims
We will remove enough of the abnormal tissue to allow you to straighten your finger or fingers.
Dupuytren
The benefits
Removing the abnormal tissue will allow you to use your hand more normally.
Are there any alternative treatments?
If you have a band of thickened fascia in your palm, but you can still straighten your fingers fully, you do not need an operation. Surgery is not necessary if you can lay your hand completely flat on a table. Not all fascial bands go on to need surgery.
If you have a band in your palm that is bending your finger at its base, it may be possible to simply cut the band in the outpatient clinic. This procedure is called a needle fasciotomy. This may delay the time until an operation is the only option.
Physiotherapy will not help. There are no tablets or injections that affect Dupuytren’s contracture.
What if you do nothing?
Your finger will probably become more bent. If the first joint of your finger becomes severely bent, it may not be possible to straighten it with surgery. This is because the joint itself may become contracted.
Who should have it done?
If you have Dupuytren’s disease and you cannot lay your hand flat, you will probably benefit from surgery.
Who should not have it done?
You should not have a general anaesthetic if you have major medical problems, such as high blood pressure or a bad heart. However, the operation may be able to be done using a local or regional anaesthetic.
Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.
© Dumas Ltd 2006
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