Needle aponeurotomy for dupuytren’s contracture of hand with extended physical therapy and serial intralesional steroid injections

Abstract

Background: Dupuytren’s disease is common benign proliferative disorder of the palmer fascia and is a part of a group of fibromatosis that includes planter fibromatosis (Ledderhose disease) and penile fibromatosis (Peyronie’s disease). It tends to present in sixth and seventh decade of life but can present earlier or later. Method: we recruited eleven patients with Dupuytren’s contracture of hand in the present study. Percutaneous release of the Dupuytren’s band was performed under local anesthetic agent with an 18 Gauze needle in outpatient department. Postoperatively all patients underwent the programme of extended vigorous physical therapy of the hand and series of triamcinolone injections at 4 monthly interval for 1 year. Result: In our study all patients were males in the age range of 48 to 78 years. Commonly involved finger was the ring finger in six patients followed by little finger in three and middle finger in two. Nine patients had right finger affected and in rest two left side fingers were affected. All patients did well and there was no recurrence of contracture in any patients during the study period. One patient experienced unexplained chronic pain in the finger. Postoperatively range of motion improved significantly after 18 months of follow-up. Conclusion: Percutaneous needle aponeurotomy with extended post-operative physical therapy and serial 4 monthly intralesional steroid injections in Dupuytren’s contracture is reliable and relatively simple to perform compared to partial aponeurectomy. This regime of treatment could be seen as a serious alternative for selected cases.