Definition

Dupuytren's contracture is a progressive disorder that affects the palmar fascia, causing the fibrous tissue to shorten and thicken, which may prevent full extension of the hand and limit function.

Commissioning Position

Treatment is not indicated where there is no contracture or it is mild (less than 20°) or not progressing and does not impair function.

NHS Scarborough & Ryedale and Vale of York CCG’s will commission surgical treatment for Dupuytren’s Contracture only in the following circumstances.

An intervention (collagenase injections; needle fasciotomy; fasciectomy and dermofasciectomy) should only be considered (and IFR approval is not required), when the patient meets at least one of the following functional difficulties:

• finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint. See here on how to measure the angles using a goniometer
  OR
• thumb contractures which interfere with function
  AND
• There is a current material impairment of hand function
  AND  
• surgery is likely to restore function.

Treatment in all other circumstances is not routinely commissioned and should not be referred unless clinical exceptionality is demonstrated and approved by the Individual Funding Request panel.

NICE concluded that collagenase treatment (Xiapex) should only be used for:

• Participants in the ongoing clinical trial (HTA-15/102/04) or
• Adult patients with a palpable cord if all of the following apply:
  • there is evidence of moderate disease (functional problems and metacarpophalangeal joint contracture of 30° to 60° and proximal interphalangeal joint contracture of less than 30° or first web contracture) plus up to two affected joints; and
  • percutaneous needle fasciotomy is not considered appropriate, but limited open fasciectomy is considered appropriate by the treating hand surgeon.
  • The choice of treatment (CCH or limited fasciectomy) is made on an individual basis after discussion between the responsible hand surgeon and the patient about the risks and benefits of the treatments available.
  • One injection is given per treatment session by a hand surgeon in an outpatient setting

Please click here to view the full Dupuytren's Contracture Commissioning Statement.  

Patient Information Leaflets (PILs)
Dupytrens Contracture Patient Information Leaflet: click here

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