Treating Dupuytren's

In many cases no treatment is necessary if the condition lies dormant, causes no problems and and does not progress.

Surgery to straighten bent fingers has long been the established method of treatment, but in recent years new treatments have become available to deal with the earlier stages of the disease. Some of these treatments, such as Radiotherapy and Collagenase injections might not yet be available on the NHS, but all are available from private clinics in the UK.

You can view an image of our treatment comparison table or download a PDF of our patient leaflet.

 

Recommended Treatments

Stage N, N1 - nodules and cords, slight or no contracture

Radiotherapy - shows promising results of halting or slowing any progression of the disease, but has minor side-effects, such as dry skin and is not always effective. It is only effective during the active or proliferation phase when nodules are growing and cords may be developing. This is often accompanied by symptoms of soreness, tingling, aches, and so on.

If there are no signs of activity then you should wait and see, but examine and possibly photograph your hands regularly for signs of changes.

Corticosterod injections - such as Triamcinolone have been used with some success by some Doctors.

 

Stage 1 and 2 - slight to moderate contracture

Needle Aponeurotomy - is a good option if any contracture is not too severe and if the cord is well away from tendons and nerves in the hand.

Collagenase injection ( Xiapex) - Has good results for contracture but carries a small risk of tendon rupture. It works by dissolving the strands of tissue in the cords or strings. Some patients need may a second injection. In most cases the contracture is straightened by the Doctor the following day or a few days after the injection.

 

Stage 3 and 4 - severe contracture

Surgery - there are different types and your your surgeon will decide which is needed. Surgery is advised when the MCP joint (the one that connects the finger to the hand) is more than 40% bent, or the PIP joint (second finger joint from the tip) is more than 20% bent.

 

Other treatments (not in general clinical use)

Tamoxifen - (Acts as Growth hormone beta inhibitor) not used because of potential serious side effects such as stroke-risk. More promising is the idea of converting the presentation to a gel or ointment for local application.

Cortisone - (steroid) injection into the nodule or cord. This lessens pain and inflammation (in theory). Temporary benefits only for most patients but some have seen a lasting reduction in nodules.

Verapamil - A calcium channel blocker, applied as a gel. Reported as effective in some cases but the cost is prohibitive. Not available on the NHS as far as we know. Penetration of Verapamil into the affected tissues has not been proven so the effect of the drug applied this way is questionable.

5 fluoro-uracil - injected into the wound area after surgery can limit scarring.

Acetyl -L - Carnitine - This is an essential amino acid, taken as tablets is reported to have good effect in some Peyronie’s cases.

Allopurinol - Xanthine oxidase inhibitor used as gout medicine. Hypoxanthine is found in high concentrations in Dupuytren’s tissue, and allopurinol can reduce this, thus reducing the amount of free radicals in the tissues. However clinical results are not very promising, and some suggest the people who benefited did so because their gout improved, not their Dupuytren’s.

Ultrasound - The idea is that it can break the disulfide bonds in the cords. Not proven very successful.

Hyperbaric Chamber - As the etiology of the nodules suggests tissue damage by hypoxia (lack of oxygen) this has been tried. One report of patient improvement.

Vitamin E ointment - Does not appear to be very successful. The idea is to ‘mop up free radicals’.

Interferon - injected into the nodule or cord. Not proven successful.

Extracorporeal Shockwave Therapy (ESWT) - clinical trial in progress.