Ultrasound-Guided Fasciotomy for Dupuytren’s Contracture
Dupuytren’s contracture is a connective tissue disorder of the palm that causes one or more fingers to gradually bend towards the palm, making them increasingly difficult to straighten fully. The condition develops as the palmar fascia – the layer of connective tissue beneath the skin of the palm – thickens and contracts.
Initially, a small nodule or thickening may appear in the palm. Over time, dense connective tissue cords may develop, restricting finger extension. The ring and little fingers are most commonly affected, although the contracture may also develop in other fingers.
If Dupuytren’s contracture restricts hand function, one treatment option is minimally invasive fasciotomy under ultrasound guidance. During the procedure, the connective tissue cord preventing full extension of the finger is divided. Ultrasound helps the physician visualise the treatment area and surrounding anatomical structures in real time.
What is Dupuytren’s contracture?
Dupuytren’s contracture is a benign, chronic connective tissue disorder of the palm affecting the palmar fascia. The connective tissue thickens and may form nodules or firm cords that gradually pull the fingers into a flexed position.
The condition usually develops slowly over months or years. Initially, changes may be limited to the skin and subcutaneous tissues of the palm, but later they may affect finger mobility.
Dupuytren’s contracture is not a tendon disorder. Finger flexion is caused by connective tissue cords rather than shortened flexor tendons.
What are the symptoms of Dupuytren’s contracture?
There may be no symptoms at the beginning of the condition. Most commonly, a person notices a small thickening in the palm that gradually becomes more pronounced.
The most characteristic signs include:
a firm nodule or thickening in the palm;
a palpable firm connective tissue cord beneath the skin;
dimpling or folds in the skin of the palm;
gradual flexion of one or more fingers;
difficulty fully straightening the fingers;
difficulty placing the palm flat on a level surface;
difficulty putting on gloves, placing the hand in a pocket or performing everyday activities;
reduced hand function.
Dupuytren’s contracture is usually not markedly painful, although nodules may be tender or cause discomfort in the early stages.
What causes Dupuytren’s contracture?
The exact cause of Dupuytren’s contracture is not fully understood. Genetic predisposition and changes in connective tissue metabolism play a role in the development of the condition.
Dupuytren’s contracture is more common:
in people with a family history of the condition;
in men;
in people over 50 years of age;
in patients with diabetes;
in people with certain metabolic disorders;
in smokers;
in people with long-term excessive alcohol consumption.
The condition may also develop in people without known risk factors. Physical strain on the hands or a particular occupation should not be regarded as the sole cause.
How is Dupuytren’s contracture diagnosed?
The physician usually makes the diagnosis during a clinical examination by assessing changes in the palm and finger mobility.
The physician evaluates:
the location of nodules and connective tissue cords;
the degree of finger flexion;
the possibility of passively straightening the fingers;
hand and finger function;
the condition of the skin and the extent of the contracture.
One simple functional assessment is the tabletop test – the patient attempts to place the palm and straightened fingers flat on a level surface. If the palm cannot be placed fully flat, this may indicate restricted finger extension.
Ultrasound in the diagnosis of Dupuytren’s contracture
Ultrasound is not always necessary to confirm the diagnosis, but it can provide additional information about the location of connective tissue cords and surrounding structures.
Ultrasound can be used to assess:
thickening of the palmar fascia;
connective tissue nodules and cords;
the depth and extent of the cords;
their relationship to the finger flexor tendons;
nearby nerves and blood vessels;
individual anatomical variations.
Ultrasound is particularly useful when planning a minimally invasive fasciotomy because it helps accurately identify the treatment site and assess a safe approach.
At the Diagnostikas centrs branch of Veselības centrs 4, a 17LH7 Hockey Stick ultrasound probe, particularly suitable for examining small joints and superficial anatomical structures, is available. It allows detailed visualisation of the connective tissues, tendons and other small anatomical structures of the hand.
How is Dupuytren’s contracture treated?
Treatment of Dupuytren’s contracture depends on the stage of the condition, the degree of finger flexion, hand function and the individual needs of the patient.
Immediate treatment is not necessary in every case. If only small nodules are present and finger movement is not restricted, the physician may recommend observation.
If connective tissue cords cause finger flexion and interfere with everyday activities, invasive treatment may be required.
Observation and non-surgical treatment
In the early stages of the condition, the physician may recommend:
regular assessment of hand and finger mobility;
monitoring changes over time;
individually tailored exercises to maintain hand function;
consultation with an occupational therapist to adapt everyday activities;
assessment of appropriate treatment options if the contracture progresses.
It is important to understand that exercises and massage cannot reliably eliminate an established connective tissue cord or straighten a pronounced contracture.
Minimally Invasive Treatment – Ultrasound-Guided Fasciotomy for Dupuytren’s Contracture
Ultrasound-guided fasciotomy for Dupuytren’s contracture is a minimally invasive procedure in which the pathologically thickened cord of the palmar fascia is divided to reduce the finger flexion caused by it.
The aim of the procedure is to improve finger extension and hand function.
Unlike more extensive open surgery, during which part of the affected fascia may be removed, in minimally invasive fasciotomy the connective tissue cord is divided rather than completely removed.
What is ultrasound-guided fasciotomy for Dupuytren’s contracture?
It is a minimally invasive surgical procedure in which the physician uses a specialised instrument through a small access point to divide the connective tissue cord causing the contracture.
Under ultrasound guidance, the physician can visualise:
the thickened palmar fascia;
the connective tissue cord causing the contracture;
the finger flexor tendons;
surrounding nerves;
blood vessels;
the position of the instrument in relation to these structures.
Ultrasound guidance helps the physician plan the procedure more precisely and reduce the risk of damage to surrounding tissues, although it cannot completely eliminate the possibility of complications.
How is the procedure performed?
The procedure is usually performed under local anaesthesia on an outpatient basis.
The physician:
Assesses the degree of finger flexion and hand function.
Uses ultrasound to identify the location of the connective tissue cord and its relationship to surrounding structures.
Selects a safe point of entry for the instrument.
Administers local anaesthesia.
Introduces a specialised instrument under ultrasound guidance and divides the connective tissue cord.
Assesses finger extension and hand function after release of the cord.
Depending on the severity of the contracture and the condition of the tissues, it may be possible to straighten the finger fully or partially after the procedure.
What are the advantages of ultrasound-guided fasciotomy?
Compared with more extensive open surgery, minimally invasive fasciotomy may offer several advantages:
a small instrument entry site;
the procedure is performed under local anaesthesia;
visualisation of anatomical structures under ultrasound guidance;
less soft-tissue trauma;
sutures are usually not required;
potentially faster return to light everyday activities.
However, the method is not suitable for all cases of Dupuytren’s contracture. Its suitability depends on the location of the connective tissue cord, the severity of the contracture and the anatomy of the surrounding structures.
Who may be suitable for the procedure?
Ultrasound-guided fasciotomy may be considered in patients who:
have been diagnosed with Dupuytren’s contracture;
have developed a clearly palpable connective tissue cord;
have one or more fingers that are flexed and cannot be fully straightened;
have restricted finger movement that interferes with everyday activities;
require correction of the contracture;
have anatomy that allows minimally invasive division of the connective tissue cord.
Suitability for the procedure is determined by the physician after an individual assessment.
Is fasciotomy for Dupuytren’s contracture an operation?
Fasciotomy is a minimally invasive procedure in which the cord of the palmar fascia causing finger flexion is divided.
An ultrasound-guided approach allows the physician to visualise the connective tissue cord and nearby anatomical structures during the procedure.
Does fasciotomy completely cure Dupuytren’s contracture?
Fasciotomy may help straighten the finger and improve hand function, but it does not eliminate the underlying tendency to develop connective tissue changes.
Dupuytren’s contracture may recur after treatment. The risk of recurrence depends on the nature of the condition, the treatment method and individual factors.
For this reason, monitoring hand function and following the physician’s recommendations after the procedure are important.
Recovery after fasciotomy for Dupuytren’s contracture
After the procedure, the following may occur:
mild swelling;
bruising;
tenderness or discomfort in the treated area;
temporary stiffness of the hand and fingers;
a small skin injury or tear at the site where the cord was released.
Recovery time is individual and depends on the severity of the contracture, the extent of treatment and the patient’s general health.
Finger mobility exercises, occupational therapy or an individually fitted orthosis may be required according to the physician’s instructions.
Light everyday activities may be resumed according to how the patient feels and the physician’s recommendations, while intensive strain on the hand may need to be temporarily restricted.
Possible risks
As with any invasive procedure, fasciotomy for Dupuytren’s contracture may involve risks such as:
bleeding or bruising;
skin tearing;
pain or tenderness at the treatment site;
incomplete straightening of the finger;
prolonged stiffness;
recurrence of the contracture;
other possible complications.
Ultrasound helps the physician navigate anatomical structures more accurately, but it cannot completely eliminate the risk of complications.
When should you see a physician?
A specialist consultation is recommended if:
a firm nodule or thickening has appeared in the palm;
a firm connective tissue cord can be felt beneath the skin;
one or more fingers are gradually becoming flexed;
it is becoming difficult to fully straighten a finger;
the palm can no longer be placed fully flat on a table;
finger flexion interferes with everyday activities;
the contracture has recurred after previous treatment.
Timely consultation helps assess the progression of the condition and select the most appropriate treatment method.
Fasciotomy for Dupuytren’s Contracture in Riga
Ultrasound-guided fasciotomy for Dupuytren’s contracture is available at the Veselības centrs 4 Diagnostikas centrs, Grebenščikova iela 1, Riga.
The procedure is performed by Dr Matīss Mežals – Algologist, Physical and Rehabilitation Medicine Physician, Ultrasound Specialist.
A physician’s consultation is required before the procedure to assess the degree of contracture and the most appropriate treatment.
