Dupuytren's Disease: Should I Have Hand Surgery?
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Dupuytren's Disease: Should I Have Hand Surgery?
1Get the |
2Compare |
3Your |
4Your |
5Quiz |
6Your Summary |
Get the facts
Your options
- Have surgery to relieve symptoms of Dupuytren's disease.
- Try other treatments instead, such as finger exercises, physical therapy, or an injection.
Key points to remember
- Surgery can improve, but may not completely restore, the use of your hands.
- Dupuytren's disease comes back after surgery about half the time. You may need another surgery to keep the use of your hands.
- There are other nonsurgical treatments for Dupuytren's. Needle aponeurotomy uses a needle to separate the tight cords in the palm. Collagenase (such as Xiaflex) is medicine that is injected to help dissolve some of the tight tissue.
- Delaying surgery until your condition is severe-for example, waiting until you are unable to use your hands to do daily activities-could make the surgery and your recovery harder.
What is Dupuytren's disease?
Dupuytren's disease (say "duh-pwee-TRAHNZ") is an abnormal thickening of tissue beneath the skin in the palm of the hand. The first symptom often is a small lump (nodule) in the palm, often near the base of the fingers. In some people, a fibrous cord may form in the palm tissue. The cord pulls the finger toward the palm. This is called Dupuytren's contracture .
If the disease gets worse, over time you may not be able to flatten your palm on a flat surface, such as a table. Severe forms of the disease can make everyday activities, such as picking up items, putting on gloves, or washing hands, difficult or impossible.
What kinds of surgery are done for Dupuytren's disease?
There are two types of surgery that can help you use your hand again:
- Fasciectomy is the most common surgery. It involves removing the thick and fibrous tissue beneath the skin of the palm.
- Fasciotomy is less common. The surgery involves using small cuts to divide the cords of fiber in the palm. It is only done in people who aren't likely to benefit from fasciectomy or whose disease has come back.
Delaying surgery until your condition is severe-for example, waiting until you are unable to use your hands to do daily activities-could make the surgery and your recovery harder.
What are other treatments for Dupuytren's disease?
- A collagenase injection (such as Xiaflex) may dissolve some of the tight tissue.
- Needle aponeurotomy uses a needle to separate the tight cords in the palm, so no cuts are made in the palm.
What are the risks from surgery for Dupuytren's disease?
Complications after surgery for Dupuytren's disease occur in about 1 out of 4 cases. footnote 1 Problems can include:
- Delayed wound healing. This is the most common problem, and it is often mild.
- Infection of the wound.
- Stiffness, tenderness, or contracture , with the fingers still being curled.
- Damage to the skin, caused by trying to surgically separate the skin from the fibrous tissue.
- Reflex sympathetic dystrophy .
Surgery can improve, but may not completely restore, the use of your hands. And it can't cure the disease. The disease can cause the tight cords to form again. Even after a successful surgery, you may need another surgery later to keep the use of your hands.
What follow-up treatment is needed after surgery?
Home treatment and physical therapy are important to the success of your surgery.
Exercises
A physical or occupational therapist can teach you how to do exercises to gently move your fingers through their normal range of motion. These exercises help prevent stiff joints. Range-of-motion exercises should not stress or overextend the joint.
Splints
Splints may be used after surgery for about 8 to 10 weeks to help restore the use of the hand and keep symptoms from coming back. Splints support your palm and help straighten your fingers during recovery.
In some cases, splints are worn only at night, but in others they are worn at all times, except when the wound needs cleaning or during finger exercises. Your doctor can teach you how and when to wear the splint.
Why might your doctor recommend surgery?
Your doctor might suggest surgery if you have tried other treatments but your fingers are increasingly bent to the palm and you can't flatten your hand.
Compare your options
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What are the benefits? |
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What are the risks and side effects? |
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- Surgery takes 30 minutes to 2 hours. You may be asleep or awake, depending on the type of surgery. You can go home the same day.
- You'll need to do finger exercises. You may wear a splint for 8 to 10 weeks after surgery.
- Surgery can restore at least some of the use of your hands and fingers.
- The disease can come back in the same place or in a new area of your hands.
- You may need another surgery to keep the use of your hands.
- All surgery has risks, including bleeding, infection, and nerve damage. Your age and your health can also affect your risk.
- You do regular finger exercises and stretching. You may wear a splint.
- Your doctor may recommend an injected medicine called collagenase.
- You may have a procedure called a needle aponeurotomy, which uses a needle to separate the tight cords.
- You may be able to keep the use of your hand and fingers without surgery.
- Delaying surgery until your symptoms are severe-for example, waiting until you are unable to use your hands to do daily activities-may make surgery and recovery harder.
- There is a small risk of damaging other tissues, such as the nearby tendons or nerves, with collagenase or with needle aponeurotomy.
Personal stories about having surgery for Dupuytren's disease
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have a mild case of Dupuytren's disease, which means my ring finger is somewhat curled and won't lie flat. I know there are risks with any surgery, so I don't want to have surgery unless I really need to. For now, I can still do all the things I need to do. Surgery is not the choice for me right now.
Richard, age 50
My fingers have lost most of their mobility, and it's increasingly difficult for me to drive or wash the dishes. For over 10 years, my doctor and I have been talking about the possibility of surgery, and I think it's time. I'm aware that the disease may return, but it's worth it to have some relief and to be able to use my hands again. I'm going to talk to my doctor about surgery and also about a simpler treatment I've heard about called aponeurotomy.
Margaret, age 65
My parents both have Dupuytren's disease, and I developed a nodule when I was still in my 30s. I exercise my hands several times a day, but my fingers are getting a little more and more bent all the time. It's getting hard to pick up objects, button my clothes, and put on gloves. I'm concerned about the risks of surgery and the good possibility that the condition will return after surgery. I'm going to try a collagenase injection to see if I can avoid surgery.
Jim, age 59
I have had symptoms of Dupuytren's disease for decades, but they are getting a lot worse. I can't stick my hands in my pockets, or pick up things, or even write. I've held off having surgery for a long time, but with the loss of finger movement, I am welcoming the relief that should come from a release of this contracture.
Ken, age 81
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for Dupuytren's disease
Reasons not to have surgery
I can't do daily activities, such as picking up things or washing my hands.
I'm still able to do everyday activities.
I've tried other treatments, and they aren't helping me.
Other treatments have helped me.
I understand that my symptoms may come back after surgery.
I'm not sure I want to have surgery if my symptoms might come back.
The risks and complications of surgery don't concern me.
I'm worried about the risks and complications of surgery.
Whatever it takes to let me use my hands again is worth it.
I'm not willing to have surgery to regain the use of my hands.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery for Dupuytren's disease
NOT having surgery for Dupuytren's disease
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery |
Dupuytren's Disease: Should I Have Hand Surgery?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Have surgery to relieve symptoms of Dupuytren's disease.
- Try other treatments instead, such as finger exercises, physical therapy, or an injection.
Key points to remember
- Surgery can improve, but may not completely restore, the use of your hands.
- Dupuytren's disease comes back after surgery about half the time. You may need another surgery to keep the use of your hands.
- There are other nonsurgical treatments for Dupuytren's. Needle aponeurotomy uses a needle to separate the tight cords in the palm. Collagenase (such as Xiaflex) is medicine that is injected to help dissolve some of the tight tissue.
- Delaying surgery until your condition is severe-for example, waiting until you are unable to use your hands to do daily activities-could make the surgery and your recovery harder.
What is Dupuytren's disease?
Dupuytren's disease (say "duh-pwee-TRAHNZ") is an abnormal thickening of tissue beneath the skin in the palm of the hand. The first symptom often is a small lump (nodule) in the palm, often near the base of the fingers. In some people, a fibrous cord may form in the palm tissue. The cord pulls the finger toward the palm. This is called Dupuytren's contracture .
If the disease gets worse, over time you may not be able to flatten your palm on a flat surface, such as a table. Severe forms of the disease can make everyday activities, such as picking up items, putting on gloves, or washing hands, difficult or impossible.
What kinds of surgery are done for Dupuytren's disease?
There are two types of surgery that can help you use your hand again:
- Fasciectomy is the most common surgery. It involves removing the thick and fibrous tissue beneath the skin of the palm.
- Fasciotomy is less common. The surgery involves using small cuts to divide the cords of fiber in the palm. It is only done in people who aren't likely to benefit from fasciectomy or whose disease has come back.
Delaying surgery until your condition is severe-for example, waiting until you are unable to use your hands to do daily activities-could make the surgery and your recovery harder.
What are other treatments for Dupuytren's disease?
- A collagenase injection (such as Xiaflex) may dissolve some of the tight tissue.
- Needle aponeurotomy uses a needle to separate the tight cords in the palm, so no cuts are made in the palm.
What are the risks from surgery for Dupuytren's disease?
Complications after surgery for Dupuytren's disease occur in about 1 out of 4 cases. 1 Problems can include:
- Delayed wound healing. This is the most common problem, and it is often mild.
- Infection of the wound.
- Stiffness, tenderness, or contracture , with the fingers still being curled.
- Damage to the skin, caused by trying to surgically separate the skin from the fibrous tissue.
- Reflex sympathetic dystrophy .
Surgery can improve, but may not completely restore, the use of your hands. And it can't cure the disease. The disease can cause the tight cords to form again. Even after a successful surgery, you may need another surgery later to keep the use of your hands.
What follow-up treatment is needed after surgery?
Home treatment and physical therapy are important to the success of your surgery.
Exercises
A physical or occupational therapist can teach you how to do exercises to gently move your fingers through their normal range of motion. These exercises help prevent stiff joints. Range-of-motion exercises should not stress or overextend the joint.
Splints
Splints may be used after surgery for about 8 to 10 weeks to help restore the use of the hand and keep symptoms from coming back. Splints support your palm and help straighten your fingers during recovery.
In some cases, splints are worn only at night, but in others they are worn at all times, except when the wound needs cleaning or during finger exercises. Your doctor can teach you how and when to wear the splint.
Why might your doctor recommend surgery?
Your doctor might suggest surgery if you have tried other treatments but your fingers are increasingly bent to the palm and you can't flatten your hand.
2. Compare your options
| Have surgery for Dupuytren's disease | Don't have surgery for Dupuytren's disease | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Personal stories about having surgery for Dupuytren's disease
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I have a mild case of Dupuytren's disease, which means my ring finger is somewhat curled and won't lie flat. I know there are risks with any surgery, so I don't want to have surgery unless I really need to. For now, I can still do all the things I need to do. Surgery is not the choice for me right now."
— Richard, age 50
"My fingers have lost most of their mobility, and it's increasingly difficult for me to drive or wash the dishes. For over 10 years, my doctor and I have been talking about the possibility of surgery, and I think it's time. I'm aware that the disease may return, but it's worth it to have some relief and to be able to use my hands again. I'm going to talk to my doctor about surgery and also about a simpler treatment I've heard about called aponeurotomy."
— Margaret, age 65
"My parents both have Dupuytren's disease, and I developed a nodule when I was still in my 30s. I exercise my hands several times a day, but my fingers are getting a little more and more bent all the time. It's getting hard to pick up objects, button my clothes, and put on gloves. I'm concerned about the risks of surgery and the good possibility that the condition will return after surgery. I'm going to try a collagenase injection to see if I can avoid surgery."
— Jim, age 59
"I have had symptoms of Dupuytren's disease for decades, but they are getting a lot worse. I can't stick my hands in my pockets, or pick up things, or even write. I've held off having surgery for a long time, but with the loss of finger movement, I am welcoming the relief that should come from a release of this contracture."
— Ken, age 81
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for Dupuytren's disease
Reasons not to have surgery
I can't do daily activities, such as picking up things or washing my hands.
I'm still able to do everyday activities.
I've tried other treatments, and they aren't helping me.
Other treatments have helped me.
I understand that my symptoms may come back after surgery.
I'm not sure I want to have surgery if my symptoms might come back.
The risks and complications of surgery don't concern me.
I'm worried about the risks and complications of surgery.
Whatever it takes to let me use my hands again is worth it.
I'm not willing to have surgery to regain the use of my hands.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery for Dupuytren's disease
NOT having surgery for Dupuytren's disease
5. What else do you need to make your decision?
Check the facts
1. Will surgery cure your Dupuytren's disease?
- Yes
- No
- I'm not sure
2. If your condition is very bad and you delay surgery, can it make your recovery harder?
- Yes
- No
- I'm not sure
3. Can other treatments be a good choice if your hand is getting worse and it is hard to do your daily activities?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Specialist Medical Reviewer | Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery |
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: March 21, 2017
