Dupuytren’s Contracture (Condition causing fingers to bend towards the palm)

(Curled finger\s into palm)

Threshold

Norfolk and Suffolk Integrated Care Board (ICB) will fund the surgical treatment of Dupuytren’s Contracture on a restricted basis.

Interventions may include needle fasciotomy or dermofasciectomy, depending on clinical presentation and functional impact

Dupuytren’s contracture is caused by fibrous bands in the palm of the hand which draw the finger(s) (and sometimes the thumb) into the palm and prevent them from straightening fully.

An intervention (needle fasciotomy, fasciectomy or dermofasciectomy) should only be considered for patients with Dupuytren’s contracture meeting one of the following criteria:

• They have finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint.

  OR

• They have severe thumb contractures which interfere with hand function

Exclusions

This policy does not cover:

• Children and young people (aged 18 and under)

Treatment for Dupuytren’s disease is not indicated in cases where there is no contracture, and in patients with a mild (less than 20°) contracture, or one which is not progressing and does not impair function.

There is currently insufficient evidence to say which interventions are the most effective in restoring and maintaining hand function throughout the rest of the patient’s life, and which are the most cost-effective in the long term. Collagenase injection is no longer available in the UK and is not recommended as an option for patients with Dupuytren’s contracture, following the withdrawal of NICE technology appraisal guidance (TA459) in February 2020.

All treatments aim to straighten the finger(s) to retain or restore hand function, but there is a risk of recurrence after any intervention. Contractures left untreated usually progress and often fail to straighten fully with any treatment if allowed to progress too far. Complications causing loss, rather than improvement, in hand function occur more commonly after larger interventions, but larger interventions carry a lower risk of need for further surgery.

Tendon injury is possible but very rare. Significant complications with lasting impact after needle fasciotomy are very unusual (about 1%) and include nerve injury. Such complications after fasciectomy are more common (about 4%) and include infection, numbness and stiffness.

Cases for Individual Funding consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.