5 Risks of Dupuytren's Contracture Treatment

Recurrence

Recurrence of Dupuytren's is almost a guarantee after treatment for contracture. Dupuytren's disease is a condition that leads to a contracture developing. Treatment of the symptom (the contracture) does not eradicate the underlying problem (the condition). Therefore, over time, the problem is likely to come back.

Current research is investigating the biology of Dupuytren's disease and, over time, we may develop systemic treatments that can alter the course of this disease. However, current treatments, including surgery, therapy, needle aponeurotomy, and collagenase injections, are all directed at the symptoms. The average time until a recurrence occurs differs between these treatments—with about 50 percent of people having a recurrence within three years of needle aponeurotomy and within five years of surgery.Trying to predict the timing, or the severity, of a recurrence is nearly impossible.

Nerve Injury

The complication of Dupuytren's treatment most feared by surgeons is usually a nerve injury. Dupuytren's cords can be closely wrapped around nerves in the fingers and sometimes the cord pulls the nerve into an unexpected location. With any invasive treatment, the nerve can be injured. When a nerve injury occurs, the finger can develop tingling or numbness and this can be a permanent problem.

While ​healthcare providers may debate the safety of different treatments, the truth is the likelihood of nerve injury is not too different with the varying treatment options. Certainly, nerve injury is best avoided by having treatment with a healthcare provider skilled in the selected treatment. For example, a surgeon who regularly performs surgery may have less chance of nerve injury with surgery than with needle treatment, but the difference is more because of the experience of the surgeon, not the specific treatment. A surgeon who regularly performs the needle aponeurotomy is likely to have a similar chance of causing nerve damage.

Pain

Pain after treatment is a frustrating problem. In general, Dupuytren's contracture is an annoying problem, but not a painful problem. However, up to 20 percent of people report significant pain after treatment of the condition.

The hand and fingers are full of nerve endings and prone to developing discomfort after treatment. Typically, the pain resolves with time, but there are some people who have chronic pain or a condition called complex regional pain syndrome that can cause ongoing discomfort and disability.

Pain after treatment from Dupuytren's contracture can often be improved with specific therapeutic activities. For many people, working with an occupational therapist or hand therapist can be beneficial. These are individuals who have specific training and helping to restore normal function to the hands and fingers. Because of the complex interaction of joints, tendons, muscles, and other structures, working with someone who has experience and expertise in the function of hands can help people who are struggling with discomfort following treatment of Dupuytren's contracture.

Skin Tears

Skin damage is surprisingly common after treatment for Dupuytren's contracture. When Dupuytren's contracture pulls the fingers into the palm of the hand, the skin can also tighten and contract. In addition, the skin becomes much less supple and flexible. 

When a release of the Dupuytren's cord is performed, the skin may need to be released or it may tear. During surgery, sometimes a skin graft is necessary to close wounds. After collagenase injections or needle aponeurotomy, the skin may tear and holes may open. These openings in the skin can become infected and painful. For this reason, skin tightness may ultimately limit the amount of improvement your healthcare provider can achieve with treatment.

Scar Tissue

Scar tissue is a result of any type of invasive treatment. With less invasive treatment, less scar tissue typically forms. With more invasive treatments, more scar tissue can form. Scar tissue is most common after surgical treatment and can ultimately limit future treatment options if and when the contracture returns down the road.

One of the frustrating aspects of treatment of Dupuytren's disease is the fact that Dupuytren's contracture causes a reaction under the skin that is very similar to the formation of scar tissue.This is one of the major reasons why clinicians are often reluctant to aggressively treat Dupuytren's. For some people, the treatment can be just as bad, if not worse than, the original problem. The hope with less invasive treatments such as needle aponeurotomy and collagenase injections is that they provide relief without the risk of development of scar tissue.