What is Dupuytren’s contracture?
Dupuytren’s contracture is a benign skin condition that first presents as bumps or nodules under the skin of the palm, which start to take on a dimpled appearance. These nodules or bumps can be seen and felt and are sometimes sensitive to pressure. As the disease progresses, the thickening and scarring of the connective tissue lying under the palm results in the formation of knots and cords.
In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers and pull one or more fingers towards the palm. At this stage, it can be difficult to perform certain functions using your hand. As Dupuytren’s contracture progresses, it can limit your ability to fully open your hand, grasp large objects or to get your hand into narrow places, affecting your quality of life.
What treatments are available for Duputren’s contracture?
Treatments for Dupuytren’s contracture may include:
- Surgery. This is the most common treatment used for advanced cases and may need to be repeated. It may be done when you have limited use of your hand. During Dupuytren’s contracture surgery, the surgeon makes a cut (incision) in your hand and takes out the thickened tissue. This can improve the mobility of your fingers.
- Steroid shot (injection). If a lump is painful, a steroid injection may help ease the pain. In some cases, it may stop your condition from getting worse. You may need repeated injections.
- Injectables. A prescription medicine injected into collagen “cord” that is causing the contracture. Some can cause serious side effects such as tendon rupture, ligament damage, and/or nerve injury.
- Needle aponeurotomy. This is another newer, less invasive procedure. Medicine is injected into the area to numb the hand. The surgeon uses a needle to divide the diseased tissue. No incision is made.
- Radiation therapy. Low energy X-rays are directed at the nodules and can soften the nodules and help keep contractions from happening. Treatment is non-surgical
What is low dose radiation therapy?
Low dose radiation therapy is an effective treatment for painful degenerative and inflammatory diseases with few side effects. The treatment itself is fast, comfortable and non-invasive, providing pain relief, preventing progression and shrinking the lumps.
- Radiation therapy reduces the growth of nodules and cords under the skin by altering the development and growth rate of fibroblasts, the cells which are responsible for creating the lumps in the connective tissue.
- Radiation therapy has an anti-inflammatory effect and may also reduce inflammation around the cords and nodules, reducing pain in the area.
What to Expect During Radiation Therapy Treatment
- Patients asked to position the hand, palm up on a flat surface, usually upon a positioning bag. The treatment machine will rest lightly on the hand during the treatment.
- Each appointment will take around 10 minutes each day, with the radiation therapy treatment itself taking just under a minute to complete.
Radiation therapy treatment for Dupuytren’s disease will usually be administered over five consecutive days (excluding weekends) and then repeated after a break. The radiation will be targeted to the same area throughout the course of treatment, even if the nodules in the hand seem to be decreasing in size. This is done to minimize the likelihood of recurrence after treatment.
The outcome of 8-year follow-up after radiotherapy for Dupuytren’s contracture:
A long-term follow-up of a study looked at the outcomes of patients who had received radiation therapy for progressive Dupuytren’s contracture and compared it with patients who chose to be observed rather than treated.1 Significant reduction in disease progression and the need for surgery was found in the patients who received radiation therapy compared to the group who did not. Overall, patients who received radiation therapy for the treatment of Dupuytren’s contracture were more than three times less likely to see their condition progress or need surgery to release a contracture, when compared to those that chose to only have their condition observed. Results from the study can be seen in the table below.
|Patient Treatment||Improvement or no change in disease||Worsening of disease||Needed surgery for a contracture|
|No radiation therapy||38%||62%||30%|
1Seegenschmiedt, MH., Keilholz, L., Wielputz, M., Hanslian, E., Fehlauer, F., Long-term outcome of radiotherapy for early-stage Dupuytren’s disease: A phase III clinical study. In: Eaton, C., Seegenschmiedt, MH., Bayat, A., Gabbiani, G., Werker, P., Wach, W. (eds). Dupuytren’s disease and related hyperproliferative disorders. New York: Springer, 2012.