Specialized Treatment for Bent Fingers and Hand Contractures
If you've noticed your fingers starting to curl toward your palm and won't straighten fully, you may be developing Dupuytren's contracture — a hand condition that can gradually limit your ability to use your hand comfortably. Many patients in Blairsville experience this condition but aren't aware that specialized treatment is available just a short drive away in Dawsonville. At Specialty Orthopaedics, board-certified orthopedic hand and upper extremity surgeon Dr. Thomas Neustein provides expert diagnosis and treatment for Dupuytren's disease and other hand contractures, offering both minimally invasive and surgical options to restore normal hand function.
Understanding Dupuytren's Contracture
Dupuytren's contracture, also called Dupuytren's disease, affects the connective tissue layer beneath the skin of the palm known as the palmar fascia. This tissue becomes thickened and forms tight cords that pull one or more fingers into a bent position. The ring finger and little finger are most often affected, but the middle finger, thumb, or other fingers can also become involved. While Dupuytren's contracture is rarely painful, it can make daily tasks like shaking hands, putting on gloves, or grasping small objects increasingly difficult.
How Dupuytren's Disease Develops
The disease progresses slowly, often over several years. It usually begins with small lumps or nodules in the palm, which feel firm beneath the skin. Over time, these lumps grow into thick cords of tissue that shorten and pull on the affected finger. The finger gradually bends toward the palm and becomes stuck in that position. Many factors contribute to the condition's development, including family history, diabetes, seizure disorders, and drinking alcohol. The condition is more common in men and tends to appear after age 40.
Early Stages and Warning Signs
In the early stages, you may notice one or more small bumps in your palm. The skin over these nodules may appear dimpled or puckered. As the disease progresses, tough cords form that pull the finger into a bent position. Most patients notice they can no longer place their hand flat on a table or fully straighten the affected finger. Over time, the deformity worsens and can involve multiple fingers. Although the process is slow, the contracture can become severe if left untreated.
How Dupuytren's Contracture Affects the Hand
As Dupuytren's contracture progresses, the tough cords pull on the finger joints, causing stiffness and limited motion. The finger remains bent, and the hand loses flexibility. While Dupuytren's contracture typically isn't painful, the pulling sensation can cause discomfort, pressure, or tenderness in the palm. The overlying skin becomes tight, and the affected area may appear thickened or scarred. In some cases, multiple fingers become involved, making it difficult to perform simple tasks like writing, buttoning clothes, or holding tools.
Dupuytren's Disease and Risk Factors
Dupuytren's disease is believed to have a genetic component, and family history plays a strong role. It is more common among people of Northern European ancestry. Risk factors include diabetes, seizure disorders, and lifestyle habits such as smoking and drinking alcohol. The condition can also be associated with other health conditions that affect connective tissue. While women can develop Dupuytren's, men are affected more often, and the disease tends to be more severe in men.
Early Diagnosis and Evaluation
A physical examination by an orthopedic hand specialist is the best way to diagnose Dupuytren's contracture. Dr. Neustein evaluates the palm and fingers for nodules, cords, and degree of finger flexion. The affected finger or fingers are tested for mobility and strength. X-rays are sometimes obtained to evaluate joint health or rule out other conditions such as arthritis or previous injury. Identifying Dupuytren's contracture early makes treatment easier and may prevent the need for more extensive surgery later.
Nonsurgical and Early Treatment Options
In mild cases or early stages, observation and splinting can slow progression. Physical therapy and splinting may relieve tension and improve motion. For patients seeking quick results, a minimally invasive procedure called needle aponeurotomy can be performed under local anesthetic. This procedure divides the tight cords using a fine needle, allowing the finger to straighten. There is minimal bleeding or swelling, and recovery is quick, with most patients returning to normal activities within days.
Needle Aponeurotomy (Needle Fasciotomy)
Needle aponeurotomy is a valuable option for patients with moderate contractures who want to avoid a larger operation. It is performed in an outpatient setting under local anesthetic without general anaesthetic. A thin needle is inserted through the skin to release the thick cords and straighten the affected finger. The procedure relieves pulling in the palm and restores motion immediately. While Dupuytren's contracture can recur over time, needle aponeurotomy can be repeated safely if needed.
Surgical Treatment for Severe Contracture
When the condition becomes advanced or affects multiple fingers, surgical treatment provides the best long-term correction. Surgery involves removing the thickened tissue and cords that cause the fingers to bend. This allows the surgeon to straighten the fingers and restore function. Depending on the tightness of the skin, a small skin graft may be used to replace overlying skin that no longer stretches fully. Surgery is performed under regional or general anaesthetic and usually takes less than two hours.
The Surgical Procedure and Recovery
During surgery, Dr. Neustein makes precise incisions to expose the tough cords and carefully releases them while protecting surrounding tendons, nerves, and blood vessels. Once the cords are removed, the finger can be straightened. The wound is closed with fine sutures, and a protective dressing is applied. Some swelling and mild discomfort are expected for the first few days, but most patients find the procedure far less painful than expected. Early motion and physical therapy begin soon after to prevent stiffness and promote healing.
Skin Grafts and Wound Care
In cases with severe contracture, removing the shortened fascia may leave a skin defect. A small skin graft is placed over the wound to allow for full finger extension. Proper wound care and splinting are important during recovery. The grafted area may require additional dressing changes, but healing typically occurs within a few weeks. Once the graft has healed, the skin softens, and the finger regains smooth movement.
Recovery and Physical Therapy
After surgery, patients wear a custom splint to keep the finger straight and prevent recurrence. Physical therapy begins shortly after the procedure to maintain motion and strength. Splinting and stretching exercises are crucial for achieving the best outcome. Most patients regain excellent motion and function within six to eight weeks. Ongoing therapy helps the tendons glide easily and prevents scar tissue from limiting motion.
Risks and Long-Term Results
As with any surgical procedure, there are small risks of bleeding, infection, or numbness. Recurrence can occur in a small percentage of patients, especially if risk factors like diabetes or alcohol use persist. However, most patients achieve long-lasting relief and improved hand function. With early diagnosis and proper care, recurrence tends to be mild and manageable. The majority of patients report excellent improvement in grip, flexibility, and overall hand comfort.
Why Patients Near Blairsville Choose Specialty Orthopaedics
Specialty Orthopaedics in Dawsonville provides comprehensive care for hand and upper extremity conditions, including Dupuytren's contracture. Dr. Thomas Neustein is a board-certified orthopedic hand surgeon with advanced training in microsurgery, tendon repair, and hand reconstruction. Many patients from Blairsville and surrounding North Georgia communities trust Dr. Neustein for his expertise in both minimally invasive procedures and complex reconstructive surgery. His approach emphasizes function, recovery, and lasting results.
Schedule a Consultation for Hand Contracture Treatment
If you live in or near Blairsville and are experiencing bent fingers, tight cords in the palm, or difficulty straightening your hand, early evaluation can make a big difference. Dupuytren's contracture progresses slowly but steadily, and timely treatment can restore motion and prevent permanent stiffness. Contact Dr. Thomas Neustein at Specialty Orthopaedics to learn about the full range of nonsurgical and surgical options available for your condition.
