New Treatment Straightens Bent Fingers without Surgery

Chris Williams

Margaret Thatcher, Bill Nighy and the author Joanne Harris are among the two million or so people in this country who are affected by Dupuytren’s Contracture, a condition which causes the fingers to become permanently bent and claw-like. Until recently, having an operation was the only way of straightening them out, but a new treatment could help suffers avoid surgery. Specialist hand surgeon Chris Williams explains more.

Dupuytren’s Contracture runs in families and can be traced back to the Vikings. It is especially common in parts of the country which were invaded, such as northeast England, Scotland and Ireland. Men are more likely to be affected than women and the symptoms generally start to develop in middle aged people.

The condition starts by small nodules of collagen growing under the skin of the palm and fingers. Eventually, these join together and form a cord that contracts and pulls the finger down towards the palm so it is at right angles to the other fingers. The little and ring fingers are most usually affected.

Having a couple of fingers out of action (and often in the way) makes every day jobs difficult – doing up buttons and shoe laces, rubbing your eyes without poking them, not to mention typing or playing the piano, can all eventually become impossible.

Usually patients with Dupuytren’s have to have surgery to straighten their fingers and regain full use of their hand. It is a major operation, taking up to three months to regain full movement and regular hand therapy is needed to help the recovery.

However, a new treatment has been developed that will mean thousands of Dupuytren’s sufferers may be able to regain full use of their hands without having surgery. An enzyme that dissolves the cord of collagen is injected directly into the problem areas. After 24-48 hours, the patient’s fingers can be manually straightened under a local anaesthetic, giving them back full use of their hand. Most people usually need only one injection for each finger and they recover much quicker than they would after surgery.

There is another non-surgical treatment but it can only be used for cases where the contraction of the fingers is not too severe. Known as a percutaneous needle aponeurotomy, this procedure divides the cord of collagen under a local anaesthetic in outpatients. It usually gets the finger straight and fully functioning in less than two weeks. However, it doesn’t halt the progression of the disease although it may put off the need for surgery by up to 10 years.

Our hands are very complex with many fine nerves and muscles that enable us to do precise and delicate tasks. Because it’s easy to damage their intricate structure, these procedures should only be carried out by an experienced hand surgeon. But both these treatments are much less invasive than surgery and can mean a much quicker return to a life where buttons and shoelaces are no longer a problem.