Dupuytren's contracture is a progressive condition affecting the connective tissue in the hand, where one or more fingers bend toward the palm. 

Even though its progression can be undulated, early diagnosis and timely management can help keep the condition from becoming permanent. 

One of the most common questions patients ask is: When should Dupuytren's contracture be treated?

Knowing when to get treatment is important for keeping your hands working well and reducing the effects of the condition. So, let's see the factors that decide the right time to begin treatment.

Detecting Early Warning Signs and Symptoms

Dupuytren's contracture generally begins as small, relatively harmless lumps (nodules) in the palm near the base of the fingers. 

This stage is often not serious and typically does not require any immediate treatment. However, this condition needs to be checked early because it worsens with time.

Signs that might indicate it's the right time to consider treatment include:

Formation of cords: 

Strands of tissue start to thicken under the skin and start pulling the fingers toward the palm.

You cannot straighten fingers fully: 

If you find that you are unable to straighten your fingers, especially when your hand is flat on an object, this may be a sign that the Dupuytren's contracture has advanced.

All cases need medical advice, even if the symptoms are at a mild level. This is to assess the progression and to explore possible treatment options.

Waiting for functional impairment 

In the past, most doctors just thought to "wait and see" about Dupuytren's contracture, especially if it wasn't affecting too much of a patient's everyday life. 

But in general, a contracture of significant size has led to enough interference with activity so that treatment is recommended.

This is generally when:

The finger cannot be straightened :

Advanced contractures to the point that one or more cannot be straightened can make it difficult to perform activities such as holding things, writing, or even shaking hands.

Daily activities are affected:

If the bent fingers make it hard to perform activities such as buttoning clothes, handling tools, or washing your hands, then treatment should be sought.

Functional impairment shows that the disease has gotten worse and that help is needed to stop more disability.

Function of the tabletop test

One of the simplest and most reliable indicators of whether or when to begin treatment is the tabletop test. You attempt to place your hand flat on a table.

 If you cannot flatten your hand because your fingers are bent, then this indicates a severe contracture. At that point, it generally is wise to start treatment.

The simple yet practical tools healthcare providers use in assessing the severity of Dupuytren's contracture are tabletop tests. The test says that if you could not lay your hand flat, it clearly means that treatment might be needed to help your hand work better.

Rapid Treatment for Rapid Progression

Some of the cases of Dupuytren's contracture progress slowly over many years. Other cases can progress fast. 

Early treatment of a patient with severe disease may be required before serious contractures set in. If you feel your condition is worsening fast, such as having many nodules or fingers bending quickly, see a doctor immediately.

In cases that worsen rapidly, early treatment can arrest the process and potentially bypass the need for more invasive procedures later on.

Least Invasive Procedures at the Early Stage

A few rather simple treatments for Dupuytren's contracture have proven to be very effective if caught early. These are usually recommended at the stage where the contracture is moderate but not at the full-blown stage. These can include:

Steroid Injections:

Corticosteroids can be injected at the beginning, which reduces swelling and slows down nodule growth.

Collagenase injections:

This treatment carries an enzyme into the tissue cords that draw the finger to the bent position so that the hand can open up.

Needle Aponeurotomy:

In this relatively minor procedure, tight subcutaneous cords are loosened by a needle, making the tight fingers easier to mobilize.

The treatments are less cumbersome compared to surgeries. However, they can be effective if taken in time before the contracture becomes too serious.

Surgery in Later Stages 

It can lead to surgery if Dupuytren's contracture progresses more severely – when the fingers bend permanently toward the palm and the ability to perform a daily routine is highly compromised. 

Surgery will be reserved for those cases in which less severe treatments were ineffective or inappropriate.

Surgical interventions include:

Fasciotomy:

Cutting the thick tissue to relieve the tightness.

Fasciectomy:

Excision of the thickened tissue to prevent contracture from recurring.

Surgery can indeed enhance hand function; however, it is time consuming and comes with a risk of complications. 

For instance, scarring can occur, and even sometimes, the condition may recur. In that case, surgery usually serves as a last resort for advanced Dupuytren's contracture patients.

The Importance of Early Intervention

Others experience Dupuytren's contracture progression; however, for most, finding the condition early and starting treatment can halt or delay it from possibly requiring surgery. 

Early treatment, especially with the less-invasive therapies, can preserve hand function, reduce contractures, and make life easier. 

Although the worst effects of Dupuytren's contracture can be prevented through early treatment of the condition, it is through regular check-ups that a health professional will be able to decide at what point the treatment should be initiated based on how the disease may be progressing.

Monitoring and Follow-up 

Even if immediate treatment is not required, Dupuytren's contracture needs regular monitoring. 

Your health professional will probably be scheduled for follow-up visits to check whether the condition is deteriorating or stable and may take action before the contracture becomes severe. 

In addition to active therapy, physical therapy and hand exercises may be recommended to preserve flexibility and strength of the hands.

Conclusion

The timing for the treatment of Dupuytren's contracture depends on how the disease is progressing and to what extent it affects the use of the hand. 

Mild early symptoms may not be treated immediately, but when the fingers begin bending or hand function is severely affected, then it is time to visit a doctor. The tabletop test is an excellent way to decide when to start treatment. 

Early, simple treatments often do the trick to slow the problem; surgery is reserved for the sicker cases. Regular checkings and prompt interventions can actually prevent most of the major disability and hand functions.