Dupuytren's contracture is a painless thickening and fixed tightening (contracture) of the tissue beneath the skin on the palm of the hand and fingers. Progressive contracture may result in deformity and loss of function of the hand.

 Medically Necessary:

Dupuytren's Contracture Release is considered medically necessary for ANY of the following:

• Contracture at the proximal interphalangeal joint or distal interphalangeal joint; or
• Rapid progression of finger contracture; or
• Symptomatic fibromatosis in the hand; or
• Contracture at the metacarpophalanageal joint that interferes with function.

Not Medically Necessary: 

Dupuytren's Contracture Release is considered not medically necessary when the criteria above are not met.

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

The cause of Dupuytren's contracture is unknown, but minor trauma and genetic predisposition may play a role.  One or both hands may be affected.  The ring finger is affected most often, followed by the little, middle, and index fingers.  Initially, a small, painless nodule develops in the connective tissue and eventually develops into a cord-like band.  Extension of the fingers becomes difficult to impossible with advanced cases.  The goal of surgery is to release or excise the fibrous attachments between the palmar fascia and the tissues around it, thereby releasing the contracture.  Once released, finger movement should be improved.

Hurst et al (2009) published the results of 308 subjects with Dupuytren's contracturs who were randomized to receive up to 3 injections of  a collagenase preparation (n=204) or placebo (n=104).  Significantly more collagenase-injected joints than placebo-injected joints showed a significantly greater percent reduction in contracture and increase in range of motion.  Currently this treatment is being reviewed by the U.S. Food and Drug Administration (FDA) for approval.

Peer Reviewed Publications:

1. Dias JJ, Braybrooke J. Dupuytren's contracture: an audit of the outcomes of surgery. J Hand Surg [Br]. 2006; 31(5):514-521.
2. Hurst LC, Badalamente MA, Hentz VR, et al.  Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009; 361(10):968-979.
3. Lee LC, Zhang AY, Chong AK, et al. Expression of a novel gene, MafB, in Dupuytren's disease. J Hand Surg. 2006; 31(2):211-218.

Government Agency, Medical Society, and Other Authoritative Publications:

1. Bayes, JH. Bunnell's Surgery of the Hand, 5th Edition. J. B. Lippincott Company, 1980:225-254.
2. Canale: Campbell's Operative Orthopaedics, 9th Edition. Mosby, 1998:3675-3684.
3. Green, David (Ed.). Operative Hand Surgery, 3rd Edition. Churchill-Livingstone, 1993:567.
4. National Institute for Clinical Excellence (NICE). Needle fasciotomy for Dupuytren's contracture. London:  2004:2. Available at: http://www.nice.org.uk/cms/ip/ipcat.aspx?c=71519. Accessed on October 20, 2009.

1. American Academy Orthopedic Surgeons (AAOS). Dupuytren's Contracture. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=140&topcategory=hand. Accessed on October 20, 2009.

Dupuytren's Contracture Release