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The risks of surgery include infection
(1-2%), stiffness, bruising, nerve injury
leaving a numb area on the finger (under
1%), and blood vessel injury (rare but if
both vessels are injured you can lose your
finger). In addition there is a high risk of
recurrence of the Dupuytren’s contracture
The hand must be elevated to prevent
swelling following the procedure and for
several days afterwards. Hand therapy
is commenced within a small number of
days after surgery unless a skin graft is
used in which case hand therapy is
delayed for a week. I usually use absorbable sutures which do not require removal.
A splint will be required at night time for
several months following most operations
and extensive exercises under the control of specialist hand therapists may be
required both to maintain the correction of
the contracture and to regain optimal hand
function. The recover time and rehabilitation time and intensity will be governed
by the pre-operative degree of contracture
and the magnitude of surgery undertaken.
ORTHOPAEDIC AND HAND SURGEON
Murdoch Orthopaedic Clinic
100 Murdoch Drive
Murdoch WA 6150
Phone: 08 9311 4636
Fax: 08 9311 4627
What is happening in my
wrist to cause carpal tunnel syndrome?
Generally a lump (nodule) appears in the
palm of your hand which often over time
become larger and resembles a cord.
The lump is most often painless but occasionally may be tender and cause some
degree of discomfort. The nodule or cord
may subsequently go on to affect one or
more fingers causing them to bend up
(contracture). When mild the contracture
usually causes no functional problems in
using your hand but if the contractures
become more severe then hand function is
Who gets Dupuytren’s
This condition can occur in almost any
adult but is more common in people of
northern European decent. Dupuytren’s
disease is more common in patients with
some diseases including diabetes, liver disease,
smokers and in people taking anti-epileptic medications.
The surgery required depends upon the
extent of your disease, and your needs and
What causes Dupuytren’s
Operating earlier in the disease before
the contracture becomes too marked but
once it becomes clear that progression
to a level that will impair function is very
likely is sensible. This way an operation can
be carried out that will result in the likelihood of as good a result as possible with
less recovery time, less requirement for too
complex a rehabilitation regime and less
The skin of the palm of your hand is different to
that of most areas of your body as it requires to be
anchored more firmly to the deeper structures to
allow grasping of objects. To enable this anchoring to be present a network of thick fibrous structures called the palmar fascia is present connecting the skin ultimately to the bones in your hand.
In Dupuytren’s disease the palmar fascia becomes
thickened and contracts causing the abnormalities mentioned above. The principal mechanism is
genetic and unfortunately we cannot cure Dupuytren’s Disease but we can treat the contracture although there is always a chance of the contracture
returning to some extent in time.
Dupuytren’s disease is not infectious or cancerous
and therefore no one absolutely requires treatment for this condition. If you have mild disease
especially if it is not progressive, you are best not
to undergo treatment initially but your hands can
be assessed over a period of time for progression.
Should the contracture be more significant then
surgery and expert rehabiliation is usually the
Surgery can take the form of simple division of the
cords using local anaesthetic and a small needle
through tiny wounds (percutaneous needle fasciotomy), injection of an enzyme which disolves
the fibrous tissue and manipulation under local
anaesthetic in the following days, removal of the
affected palmar fascia through small to moderately sized wounds (palmar fasciectomy), or removal
of the affected fascia and skin and skin grafting
Percutaneous fasciotomy and manipulation
following collagenase injection is carried
out under local anaesthetic and these procedures have a relatively rapid recovery.
For fasciectomy operations a general anesthetic is most often utilised and a tourniquet
is used to reduce bleeding and the wounds
are dressed by a moderately large bandage or plaster splint.
Collagenase Injection For
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