DEAR DR. GOTT:
I am a 70-year-old male. I have developed Dupuytren’s contracture in my left hand affecting the little finger. My hand doctor told me it is stage one and recommended surgery. I am hesitant to have any surgery as I play the guitar and am concerned with possible complications.
I have done minimal research and found that there is a non-invasive procedure called “needle aponeurotomy” that has little or no complications. Do you think this procedure is a viable alternative?
DEAR READER:
Dupuytren’s contracture is a common malady of the hand that causes the connective tissue of the palm to contract. Over time the tissue then toughens and can form lumps, knots and cords. Most people also experience bending of one or more the fingers as the tissue tightens. The little finger is most commonly affected with the ring and middle fingers also affected in more severe cases.
Closing the hand remains unaffected. The fingers that are pulled by the tissue take on a bent appearance and cannot be straightened. Often the Dupuytren’s is not painful but the knots of tissue on the palm may be sensitive to touch.
Most cases of Dupuytren’s progress slowly, often over several years. In some cases, the progress may take only months. Some experience progressive worsening while others may have only minimal damage which then stops on its own. Others may never experience the bent fingers commonly associated with the condition. Rarely, some individuals may even get better without treatment.
Treatment consists of several non- or minimally invasive techniques and surgery. Steroid injections, radiation therapy and needle aponeurotomy (NA) are good places to start. You have already done some research and found NA. This procedure is minimally invasive and has few complications. Only physicians who are experienced in this procedure should attempt it as it requires careful, accurate use of a needle to puncture and “break” the cords in the palm to release the affected finger. It is not a cure and the contractures may return necessitating repeat procedures.
Surgery is a last resort for those who have disabling symptoms from the Dupuytren’s. The extent of the surgery depends on the severity of the tightening. For those who cannot undergo more extensive forms, the physician may choose simply to release the cords cutting them such as is done in NA. Recurrence is common. The most common type of surgery involves removing as much of the diseased tissue as possible. There is still a chance of recurrence but it is often minimal and to a lesser degree that does not need further surgical treatment. For younger individuals or those with very severe symptoms, the surgeon may recommend complete removal of the tissue. This also means that skin grafting must be done. Recurrence is rare but the surgery itself carries serious side effects such as finger stiffness or an inability to bend the fingers. In some cases these can be more severe and disabling than the Dupuytren’s.
A final surgical option is reserved only for those who experience repeated occurrences despite several surgeries. Finger amputation, often the little finger, can be beneficial in cases where surgery does not work. By removing the finger, the diseased tissue still contracts but can no longer pull the finger or fingers down leading to disability.
I believe you would do well to avoid surgery. Find a physician experienced in NA and get a second opinion.
