Finding the right orthopedic surgeon in DeLand, Florida, often starts when a simple handshake feels awkward or you notice a hard lump in your palm. Dupuytren’s Contracture creeps up slowly, but catching it early makes a massive difference in your treatment options. Ignoring that curling finger won't make it go away, and waiting too long reduces the chances of fully restoring your hand function.
What Is Dupuytren’s Contracture?
Dupuytren’s Contracture is a genetic hand condition where the tissue under the palm's skin thickens and tightens over time, causing fingers to pull inward toward the palm. It affects roughly 15 million Americans aged 35 and older, primarily men of Northern European descent. While it's not usually painful, the restriction it places on your hand can severely limit your ability to perform basic tasks like washing your face or putting on gloves.
The condition involves the palmar fascia, a layer of tissue that sits between your skin and the tendons. In a healthy hand, this fascia is flexible. With Dupuytren’s, collagen builds up abnormally, forming ropes or "cords" that anchor the skin to the deeper structures. As these cords tighten, they physically drag the fingers down. It most commonly affects the ring and pinky fingers, but it can impact any digit.
Here in Volusia County, where we have a robust population of retirees and active seniors, we see this condition frequently. It’s often hereditary, so if your father or grandfather had hands that looked "clawed," pay close attention to your own.
How Do I Know If I Have It?
You'll typically spot Dupuytren’s Contracture by seeing small, pitted nodules or lumps in the palm of your hand that may feel tender at first but usually stop hurting as they harden. As the condition advances, you might see thick cords of tissue extending from your palm up to your fingers. The ultimate sign is the inability to lay your hand flat on a table.
We use the "Table Top Test" to gauge severity. Place your hand palm-down on a flat surface. If you can't flatten your hand or fingers completely, the contracture has progressed to a stage where medical intervention is likely necessary.
Symptoms generally follow this timeline:
- Nodules: Small lumps form in the palm.
- Cords: The lumps thicken into bands of tissue under the skin.
- Contracture: The cords tighten, pulling fingers toward the palm.
Unlike trigger finger or arthritis, the joints themselves aren't the problem initially—it's the tissue covering them. However, leaving the fingers bent for years can eventually damage the joints permanently.
Why Is Early Diagnosis So Important?
Catching Dupuytren’s early gives you access to less invasive treatments that recover faster and cost significantly less than major surgery. Once the finger bends past a certain degree—typically 30 degrees for the main knuckle—your options narrow, and the risk of permanent joint stiffness skyrockets.
Think of it like foundation repair on a home in Victoria Park. If you fix a small crack early, it’s a minor expense. If you wait until the wall is leaning, the repair becomes a major construction project.
Patients who see an orthopedic surgeon in DeLand, Florida, while their hand is still relatively flat might qualify for needle procedures or enzyme injections. These treatments allow you to return to normal activities, like golfing at Victoria Hills or fishing on the St. Johns River, within a week or two. Waiting until the finger curls into the palm often forces us to perform open surgery, which requires months of rehabilitation.
What Treatment Options Are Available in DeLand?
Treatments for Dupuytren’s range from simple in-office procedures to complex surgical release, depending entirely on how far the contracture has progressed.
Needle Aponeurotomy
This is a minimally invasive procedure performed under local anesthesia. We use a fine needle to puncture and weaken the tight cords of tissue, then snap them to release the finger.
- Best for: Mild to moderate contractures where the cord is distinct.
- Recovery: 24 to 48 hours for light use; 1 week for full activity.
- Cost Estimate: $1,000 to $3,000 (often covered by insurance).
- Recurrence: High (50% recurrence within 3-5 years), but the procedure can be repeated.
Enzyme Injections (Xiaflex)
We inject an enzyme called collagenase clostridium histolyticum directly into the cord. This enzyme dissolves the collagen buildup. You return to the office 24-48 hours later, and we manually manipulate the finger to break the cord.
- Best for: Patients who want to avoid surgery but have a palpable cord.
- Recovery: Splinting for a few days; return to normal use in 2 weeks.
- Cost Estimate: The medication is expensive, often ranging from $3,000 to $4,000 per injection series, plus provider fees. Insurance coverage varies significantly here.
- Recurrence: Similar to needle aponeurotomy.
Open Fasciectomy (Surgery)
This is the traditional surgical approach where we make an incision and remove the thickened tissue entirely.
- Best for: Severe contractures or recurrent cases.
- Recovery: Requires physical therapy. 6 weeks for skin healing, 3 months for full strength.
- Success Rate: Lowest recurrence rate (about 15-20%), but longer recovery.
Why Timing Matters for Your Hands
Treatment effectiveness drops sharply if you wait until the finger is severely bent, because the skin shrinks and the nerves shift position, making surgery riskier and less successful. When a finger stays bent for years, the joint capsule stiffens, and the skin on the palm shortens. Even if we cut the cord, the finger might not straighten fully because the other structures have adapted to the curled position.
The functional impact is real:
- Hygiene: It becomes difficult to wash your hands or face.
- Safety: You may struggle to grip a steering wheel firmly or catch yourself during a fall.
- Lifestyle: Simple joys like putting hands in pockets, wearing gloves, or typing become frustrating struggles.
Financial costs also increase with time. A simple needle procedure might cost a few hundred dollars in copays. A full surgery with anesthesia, facility fees, and weeks of physical therapy can easily run $5,000 to $10,000 or more before insurance kicks in.
Choosing Central Florida Bone & Joint Institute
At Central Florida Bone & Joint Institute, we focus on restoring your quality of life through personalized orthopedic care right here in DeLand. You don't need to travel to Orlando for world-class hand treatment.
Our approach includes:
- Detailed Assessment: We don't just look at the hand; we look at how you use it. Are you a carpenter? A pianist? A retiree who loves gardening? This shapes our treatment plan.
- Conservative First: We explore every non-surgical option before recommending the operating room.
- Local Follow-up: Recovery requires monitoring. Being close to your surgeon in DeLand means you can easily attend follow-up appointments without a long commute on I-4.
In our years serving Volusia County, we’ve found that patients who have a local support system and a surgeon nearby tend to adhere better to their rehabilitation protocols, leading to better long-term results.
What Happens During Your Consultation?
During your first visit, we will perform a physical examination to map the location and severity of the nodules and cords. We measure the degree of contracture in each joint using a goniometer (an angle-measuring tool).
We will also check:
- Sensation in your fingers to rule out nerve involvement.
- Grip strength compared to your unaffected hand.
- Range of motion in the wrist and fingers.
Based on this data, we create a tailored plan. If your contracture is less than 20 degrees, we might recommend "watchful waiting," where we monitor the hand every 6 months. If it's more severe, we discuss intervention.
Risks and Recovery: What You Need to Know
Every medical intervention carries risk, and treating the hand requires extreme precision because the nerves that supply feeling to your fingers often wrap around the Dupuytren’s cords.
Potential Complications:
- Nerve Injury: There is a small risk of damaging the digital nerve, which can cause numbness. This risk is higher in revision surgeries.
- Skin Tears: In severe cases where the skin has shortened, straightening the finger can tear the skin, requiring skin grafts.
- Recurrence: Dupuytren’s is a chronic condition. While we can remove the current cords, your body may produce new ones in the future.
Rehabilitation Timeline:
- Week 1: Hand is bulky wrapped or splinted. Keep elevated to reduce swelling.
- Week 2-4: Stitches removed (if surgery). Night splinting begins to keep fingers straight while sleeping. Hand therapy exercises start.
- Month 2-3: Scar massage helps soften the incision site. Grip strength exercises intensify.
- Month 6: Most patients have returned to full, unrestricted activity.
Ready to Fix Your Hand Function?
Don't let curled fingers limit your life or your hobbies. If you can't lay your hand flat on the table, it's time to see a specialist. Early intervention is the key to a faster, easier recovery.
Central Florida Bone & Joint Institute
We are ready to help you regain control of your hands.
Phone: (386) 775-2012
Website: https://www.floridaboneandjoint.com/
Schedule your evaluation today. The sooner we look at it, the more options you have.
References:
[1] American Academy of Orthopaedic Surgeons (AAOS). "Dupuytren’s Contracture." OrthoInfo.
[2] American Society for Surgery of the Hand (ASSH). "Dupuytren’s Contracture." HandCare.