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Dupuytren’s Contracture in Ventura, CA

Dr. Pickart offers treatment for Dupuytren’s contracture to the residents of Ventura, Camarillo, and the surrounding areas of California.

What Is Dupuytren’s Contracture?

The palmar fascia is a durable tissue beneath the skin that both anchors the skin and also protects the palmar tendons, nerves, and blood vessels.  In some people, especially older White men, the palmar fascia inexplicably thickens.  This is known as palmar fibromatosis or, more colloquially, as Dupuytren’s Disease.

A Dupuytren’s contracture occurs when the thickening of the palmar fascia progresses.  Nodules coalesce into a cord, which bends a finger into a flexed position.  The ring and small fingers are most commonly affected.  Contractures can also occur in the web spaces between the bases of the fingers, which make it difficult to separate the fingers from each other.

What Is the Cause of Dupuytren’s Contracture?

The cause of Dupuytren’s disease is unknown. The condition has not proven to be the result of occupational hazards or overuse of the hand.

The condition definitely runs in families, so there is likely a genetic component. Classically, people of northern European descent were thought to be more susceptible, but studies of Asian immigrants to Northern Europe show rates of Dupuytren’s disease approaching that of the native population.

Who Usually Contracts the Condition?

Older White men.  The risk of Dupuytren’s disease does increase with age.  Having a Northern European background may increase risk.  Men are definitely more often affected than women.

What Are the Symptoms of the Disease?

Usually, a patient first notices lumps or nodules in the palm. As the disease progresses, thick cords may be seen, running from the palm and into the fingers, especially the ring and little finger of the hand. The cords may cause the fingers to bend toward the palm.

Although the disease is not painful, it can interfere with activities of daily living, such as washing, putting on gloves, or shaking hands.

How Is the Condition Treated?

If Dupuytren’s disease is limited to painless nodules, then the patient is provided with reassurance and with monitoring.  However, if a Dupuytren’s cord causes a contracture that limits hand function, then intervention is necessary.

What Are the Minimally Invasive Options?

The two non-surgical options are needle aponeurotomy and collagenase injections. Dr. Pickart is wary of both.

A needle aponeurotomy involves the insertion of a needle into the palm adjacent to the affected digit. The needle is used to cut through the cord that is causing the flexion contracture.
This percutaneous technique has the advantages of ease, convenience, minimal pain, and minimal downtime. However, Dr. Pickart rarely advocates this option because of the risk of injury to critical structures; because of an inadequate visualization of nerves, arteries, and tendons, there is high risk of inadvertent damage.

Collagenase injections also involve needles. The needle is used to inject an FDA-approved enzyme that destroys collagen, such as the excessive collagen of a Dupuytren’s cord.
Like the needle aponeurotomy, the simplicity of a collagenase injection is attractive. However, the inadvertent destruction of the collagen of tendons, nerves, arteries, etc., makes Dr. Pickart hesitant to use collagenase in most patients.

Research with collagenase injections is demonstrating that they are a much safer non-surgical option than needle aponeurotomies. For the oldest, most infirm patients, who are not good surgical candidates, collagenase injections do appear to hold promise.

What Is Involved in Dupuytren’s Surgery?

While rehabilitation takes longer for a palmar fasciectomy, the rates for recurrence are lower, compared to non-surgical treatments.  Hand therapy is often indicated to aid in recovery, which can take as long as six months.

What Is Involved in the Recovery Process?

While rehabilitation takes longer for a palmar fasciectomy, the rates for recurrence are lower, compared to non-surgical treatments.  Hand therapy is often indicated to aid in recovery, which can take as long as six months.

How Much Does Treatment of Dupuytren’s Contracture Cost in Ventura?

Usually, the surgical and non-surgical treatments for Dupuytren’s disease are covered by your insurance company.  Pickart Plastic Surgery currently works with most insurance carriers to ensure that patients can receive high quality treatment. Dr. Pickart also offers CareCredit® and Capital One® to provide financing options for patients.

Dr. Pickart specializes in hand surgery; visit our other hand surgery pages including hand arthritis, trigger finger, and ganglion cysts.

If you are a resident of Ventura, Camarillo, or the surrounding areas in California and are considering cosmetic or reconstructive surgery, call Pickart Plastic Surgery at (805) 232-5688. Our talented staff members can answer all your questions and also schedule your consultation.

Written by Pickart Plastic Surgery August 13, 2013