This tightening of the tissue in the palm, called the fascia, pulls the fingers down into the palm making simple activities difficult—especially as the condition worsens. For this reason, many people with this condition seek treatments to help improve the function of the hand. Different treatments may have different risks.
Here are some of the more common complications that can occur for treatment of Dupuytren’s contracture.
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.
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.
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.
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.
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.
