Dupuytren’s contracture is a progressive hand condition where tissue beneath the palm’s skin thickens and tightens. This forms cords that pull the fingers into a bent position. The disorder, often hereditary, typically begins with firm nodules in the palm, commonly near the ring and little fingers. While usually painless, the resulting inability to fully straighten the fingers can interfere with daily activities. Understanding which specialists manage this disease is key to effective treatment.
The Initial Consultation and Diagnostic Process
The first step in addressing new stiffness or a lump is usually a visit to a Primary Care Physician (PCP). This initial consultation confirms the suspected diagnosis and determines the condition’s severity. The doctor performs a physical examination, inspecting the palm for skin dimpling and palpating the area for characteristic nodules and thick cords.
A standard diagnostic tool is the tabletop test, where the patient attempts to place their palm flat on a surface. Inability to lay the hand flat suggests a contracture is present, signaling that treatment may be needed to restore function. The PCP also takes a detailed medical and family history, noting risk factors such as diabetes or a family history of the disorder. Since Dupuytren’s contracture is primarily a clinical diagnosis, advanced imaging like X-rays or MRI scans is rarely necessary. The PCP’s main role then shifts to referral, connecting the patient with a specialist for definitive treatment and long-term management.
Primary Medical Specialists Who Treat Dupuytren’s
Definitive treatment for Dupuytren’s contracture is managed by surgical specialists focusing on the hand and upper extremity. These specialists, often designated as hand surgeons, possess the anatomical knowledge and skill required to address the thickened fascia and restore function. Hand surgery is a subspecialty drawing from both orthopedic and plastic surgery fields.
Orthopedic surgeons specializing in the hand focus primarily on the musculoskeletal aspects of the condition, including joints and tendons affected by the contracting tissue. They are trained in hand biomechanics and are well-suited for cases involving joint stiffness or complex skeletal considerations. Many hand surgeons are fellowship-trained, completing additional focused training after residency, which provides experience in a wide range of hand disorders.
Plastic surgeons specializing in the hand manage the soft tissues and skin of the palm. Their expertise is beneficial in advanced cases where the contracted fascia adheres tightly to the skin, requiring meticulous dissection and potentially a skin graft after the diseased tissue is removed. Hand surgeons, regardless of their orthopedic or plastic surgery background, are the primary experts for all stages of Dupuytren’s contracture. While other specialists like physiatrists or rheumatologists may assist with rehabilitation or initial assessment, procedural intervention remains the domain of the hand surgeon.
Surgical and Non-Surgical Interventions
The treatment strategy is determined by the contracture’s severity and the extent of functional impairment. For less severe contractures, non-surgical or minimally invasive options are preferred. One treatment is the injection of Collagenase Clostridium Histolyticum, an enzyme that breaks down the collagen in the cord tissue. Following the injection, the physician manually manipulates the finger a few days later to rupture the weakened cord and straighten the digit.
Another minimally invasive approach is needle aponeurotomy, or percutaneous fasciotomy, performed under local anesthesia. This technique uses a fine needle inserted through the skin to puncture and divide the contracting fascial cord. The procedure avoids a large incision, allowing for quicker recovery time and often being performed in an office setting.
Surgical intervention, such as fasciectomy, is reserved for advanced cases where the contracture impedes hand function. During the procedure, the hand surgeon makes an incision to access and remove the diseased palmar fascia. A partial palmar fasciectomy, the most common approach, involves removing only the affected cords. In severe or recurrent cases, a total fasciectomy, removing all the fascia in the palm, may be necessary and can require a skin graft to close the resulting wound. Although recovery is longer, surgery provides lasting release of the contracture, especially when joints are fixed.
Selecting the Right Specialist for Your Care
After confirming the need for specialized treatment, the next step is selecting the appropriate practitioner. It is important to confirm the specialist holds board certification in their primary field (e.g., Orthopedic or Plastic Surgery) and has completed a fellowship specifically in hand and upper extremity surgery. This fellowship training indicates a focused dedication to conditions like Dupuytren’s contracture.
Experience level with specific procedures is a factor in achieving the best outcome. When considering non-surgical options like collagenase injection, inquire about the doctor’s volume of experience, as manufacturers often track high-volume providers. For surgical options, selecting a hand surgeon who performs a high volume of fasciectomies is beneficial, as expertise correlates with procedural frequency. Patient referrals and testimonials can also provide insight into a provider’s reputation and skill.