Surgery treats palmar fascia disorder

Dear Dr. Roach: I am a 76-year-old female who was recently diagnosed with bilateral Dupuytren’s contracture. Currently, there is only a small lump in the palm of each hand, and there is no finger curling or other problem or pain. Is it better to get this surgically corrected as soon as possible, or wait until there is contracture and interference with the use of my hands?

K.V.G.

Answer: Dupuytren’s contracture is a disorder of the palmar fascia, which is a thick, strong, connective tissue on the palm of the hand. The fascia provides support for the structures of the hand. It is not known what causes Dupuytren’s contracture, but it starts slowly with a thickening of the fascia and progresses over years or decades. Eventually, one or more fingers flex or curl toward the palm as though to make a fist, and are unable to be straightened.

While some authorities recommend massage, splinting or exercise in early stages of the condition, it isn’t clear that this helps slow down progression. Injections of corticosteroids may be used, particularly for people with painful nodules.

Definitive treatment has been achieved with surgery, either an open surgery or sometimes with a needle procedure. The specific treatment depends on a person’s condition and age, and an experienced surgeon is necessary to provide guidance.

Your question is about when to consider surgical treatment, and most authorities recommend surgery when function is impaired or when more advanced contracture is progressing. The goal of surgery is to restore hand function and reverse contractures. Given that you have no symptoms and very early disease, I do not think a surgeon would recommend surgery for you at this time.

An additional option is injection of collagenase, an enzyme that dissolves connective tissue, and is an alternative for people who want to avoid surgery. It is best suited for people with early disease with less-severe contractures. Radiation also has been used, but it is unknown how well it compares with other treatments.

You’ll want to see a hand surgeon experienced in this condition.