Dupuytren

Dupuytren’s contracture, also known as Morbus Dupuytren, can be defined as a scaring of the palmar ligament of the hand. The fibrous tissue in the palm thickens and shortens resulting in a progressive and irreversible bending of one or more fingers towards the palm.

This deformity is linked to a genetic pool of approximately 5% of the North European population. Eighty percent of the time this disease affects men with an average starting age of 50 years old.

Dupuytren’s contracture is more likely to occur in epileptic, diabetic, alcoholic and manual working patients.

Considered since its description in 1831 as a surgical disease, its treatment has been revolutionized by the emergence of a new technique : aponevrotomy with the use of a needle. This treatment is a non-surgical ambulatory procedure, it is quick, successful and low cost. Furthermore, it can easily be performed in the city (or during an external consultation) by an experimented doctor.

Aponevrotomy by needle was proposed about twenty years ago by rheumatologists from the Laribosière Hospital in Paris under the impulsion of Dr J.L. Lermusiaux. It should nowadays be the first treatment proposed to patients suffering from Dupuytren’s contracture.

The publication of studies that were made on a significant number of patients treated with aponevrotomy by needle (123 hands et 992 hands) allowed to establish the high effectiveness of this treatment, on a short and long term, and its safety when performed by experimented hands.

The results obtained after five years show that the recurrence rate is comparable to the one of surgical aponevrotomy although the recurrence might appear a bit earlier. Nevertheless, this inconvenient is compensated by the possibility of redoing a session of aponevrotomy by needle as soon as a recurrence appears to be embarrassing whereas the surgical treatment of recurrences is very problematic.

What does aponevrotomy by needle consist in ?

Aponevrotomy by needle is an ambulatory treatment practiced under local anesthesia at the doctor’s office and not in an operating room, without tourniquet or loco-regional anesthesia.

The procedure consists in realizing one or more sections through the skin of the aponeurotic cords using the bevelled edge of the needle used to inject the local anesthetic. The section is obtained by conveying saw movements to the syringe. The cutting edge of the needle cuts and perforates crosswise the cord whose rupture is completed, if needed, by an energetic extension of the finger.

A dry bandage, held by an elastic adhesive strip, is kept three days during which the patient must prevent it from getting dirty or wet.

As soon as the session of about fifteen minutes is over, the patient can use his hand for acts of current life but has to prevent himself from doing any intense effort during ten days. This treatment does not require any re-education or medical care. The need of work stoppage is rare.

The large majority of patients are treated within less than three sessions whereas the treatment of recurrences after surgery gives inconstant results.

The risks linked to aponevrotomy by needle, when realized by an experimented professional, are minor : early recurrence, cutaneous crack and tear, transitional loss of sensitivity, et very rarely drawling pain, benign superficial infections, vasovagal syncope, inflammatory reactions and hematoma.

Dupuytren’s contracture can thus be treated efficiently which gives great hope to the many patients who are handicapped in their every day life by their retracted fingers.