Dupuytren’s contracture is a condition characterized by the abnormal proliferation of fibroblasts in the palmar fascia, leading to the thickening of the fascia and resulting in the inability to extend the fingers. While pain is generally absent, severe contracture may compress the nerves and cause discomfort. This condition predominantly affects the fourth and fifth fingers and typically occurs in older adults, particularly between the ages of 55 and 75 years, with a higher prevalence in males [1]. Although the exact cause of Dupuytren’s contractures remains unclear, several studies have suggested that factors such as alcohol consumption, diabetes, and genetic predisposition may play a key role [2]. Recent research has indicated that the prevalence of Dupuytren’s contracture in Korea is approximately 32.2 per 100,000 individuals, which is significantly lower than that in Western countries. The prevalence was higher in males (41.8) than in females (22.5). Moreover, among the comorbidities of patients with Dupuytren’s contracture, hypertension, diabetes, and hyperlipidemia were the most common. [3].

Treatment options are generally divided into nonsurgical and surgical approaches. Particularly in the early stages, when nodules are present without contracture formation, nonsurgical methods are primarily used. These methods include pharmacological therapy, physical therapy, and radiotherapy. Pharmacological treatments often involve steroid injections and vitamin E administration, whereas physical therapy may include ultrasound therapy, splinting, massage, and heat therapy [4]. Moreover, among the non-surgical treatments, collagenase clostridium histolyticum (CCH) injection has been considered an effective treatment option for Dupuytren’s contracture [5].

Surgical treatment options include fasciectomy and fasciotomy. The distinction between these two methods lies in their approaches: fasciectomy involves the removal of the contracted tissue in the palmar fascia, whereas fasciotomy involves a simple incision to improve movement. Both techniques have shown positive therapeutic effects in the treatment of Dupuytren’s contractures based on various studies; however, surgical complications and side effects have also been reported [6].

Among the various treatment modalities, CCH injection, fasciectomy, and fasciotomy are predominantly used, with extensive ongoing research aimed at determining the most effective and efficient method. One study has found that all three methods yielded nearly similar results in terms of contracture resolution; however, fasciectomy provided superior long-term benefits in terms of recurrence rates and patient satisfaction compared with the other two methods [7]. Another study also reported that CCH and fasciotomy resulted in less physical impairment than fasciectomy and confirmed that, one year post-treatment, CCH had fewer side effects, such as stiffness and weakness, compared with fasciotomy [8].

To determine the most appropriate treatment for Dupuytren’s contracture, considerations should extend beyond the degree of contracture resolution, recurrence, and complications. Factors such as economic burden and esthetic concerns should also be considered when tailoring treatment to the different needs of the patients.

Currently, research on the traditional Korean medical treatment of hand disorders, such as carpal tunnel syndrome and trigger finger, is actively progressing in South Korea. Various treatment methods are used, including basic acupuncture, pharmacopuncture, warm needling, and thread autotomy. These Korean medical treatment approaches may also be effective for Dupuytren’s contracture. However, the domestic and international research trends regarding this condition have not been fully investigated. Thus, we aimed to analyze the research articles on traditional Korean medicine related to Dupuytren’s contracture to report trends in the treatment of this disease.

1. Data and web search sources

This study targeted articles published both domestically and internationally. The following six databases were used: Korean Studies Information Service System (KISS), Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Sharing Service (RISS), PubMed, Embase, and Cochrane Library. The search term “Dupuytren” was used in KISS and OASIS, while in PubMed, Embase, Cochrane Library, and RISS, the combinations of the terms “Dupuytren,” “acupuncture,” “acupotomy,” “Korean medicine,” “Chinese medicine,” “pharmacopuncture,” “moxibustion,” and “cupping” were used.

2. Data selection

The selected studies were limited to those published after 2000, and only those in which Korean medicine was the primary treatment method were included. The Korean medical treatments included acupuncture, warm needling, pharmacopuncture, and autotomy. Clinical studies, including randomized controlled trials and case reports, were adopted without distinction, and review articles were excluded.

A total of 146 studies were identified based on the search methodology from the respective databases. After reviewing the titles and abstracts, 130 studies that did not involve Korean medical interventions were excluded, resulting in a total selection of 16 studies. Of these, seven duplicate studies were excluded, resulting in a total of nine studies. One study published in the 2000s, one addressing postsurgical treatment, and one for which the full text could not be located were excluded. Moreover, one study using radio-frequency hyperthermia therapy as the main intervention was excluded because it did not represent conventional Korean medical treatment. Consequently, a total of five studies were selected for analysis (Fig. 1).

Figure 1. Paper selection flow chart. KISS, Korean Studies Information Service System; OASIS, Oriental Medicine Advanced Searching Integrated System; RISS, Research Information Sharing Service.

3. Data analysis

The five selected papers [9-13] were all case reports, with four reporting individual cases and one [11] documenting a total of 16 cases. These studies were analyzed based on various factors, including journal and publication year, patient information, affected areas of the hand, treatment interventions, and evaluation methods (Tables 1, 2).

Table 1 . Patient information included in each study.

Study, y	Journal	Patient information
		Sex/age (y)	Affected area	Treatment duration/number
Kim, 2023 [9]	Medical Acupuncture	M/63	Right hand	12 weeks/12 times
Kotlyar and Stone, 2023 [10]	Medical Acupuncture	F/62	Right fifth DIP	5 weeks/10 times
Chen and Wang, 2018 [11]	Zhongguo Gu Shang (China Journal of Orthopedics and Traumatology)	11 males and 5 females/48–79 (mean age, 58.5)	Twenty-five fingers (16 people) - 4 middle fingers, 12 ring fingers, and 9 little fingers - both, 2; single, 14 (left, 8; right, 6)	One time each
Bang et al., 2016 [12]	The Acupuncture	F/73	Left 4 and 5 fingers and palm	5 weeks/30 times (3 weeks/9 times for bee venom pharmacopuncture)
Jun et al., 2018 [13]	Journal of the Spine and Joint Korean Medicine	F/57	Left fourth finger	1 week/6 times

M, male; F, female; DIP, distal interphalangeal joint..

Table 2 . Interventions, evaluation, and results.

Study, y	Intervention	Evaluation	Result
Kim, 2023 [9]	1. Acupuncture - LI-4, TE-5, LI-10, HT-7, and PC-7 - R: 30 min 2. Moxibustion (indirect) - PC-8 - R: 30 min	1. Pain 2. ROM 3. Grip strength	1. Decreased pain (having pain at times but not affecting his daily activities or causing him discomfort) 2. Full ROM in his fingers 3. Improved grip strength; he was able to perform daily activities with ease
Kotlyar and Stone, 2023 [10]	1. Acupuncture (ICBA) - SI + BL 65, 66	1. Pain 2. ROM	1. A complete dissipation of pain 2. Gradual straightening of the finger and restored mobility range
Chen and Wang, 2018 [11]	1. Pi needle - Three to four points on the lateral side of the affected finger	1. Adam and Loynes’s [14] evaluable standard	1. 100% (22 fingers), 75% (2 fingers), recurred (1 finger) → excellent, 22; good, 2; poor, 1
Bang et al., 2016 [12]	1. Acupuncture - Four Ashi points including HT-8 - Depth: 5–7 mm - R: 20 min 2. Moxibustion (indirect) - Same as the acupuncture points, twice at each site 3. Bee venom pharmacology - B4-eBV 0.1 mg/mL (10%, 1:10,000) - Same as the acupuncture points - 0.4 mg (0.1 mg/point) - Depth: 5–7 mm	1. Constructed joint angle 2. Tubiana’s grade system	1. 4th: 70° → 50° (MCP), 70° → 60° (PIP), 15° → 15° (DIP)5th: 65° → 50° (MCP), 60° → 50° (PIP), 20° → 20° (DIP) 2. 4th: grade 4 → 35th: grade 4 → 3
Jun et al., 2018 [13]	1. Warm needle acupuncture - Two trigger points including HT-8 - Insert the needle to a depth of 5–7 mm, and place the moxa on top - R: 10 min 2. Herb medicine - Hyungbangsabaeksan (2 doses per day, 3 times daily) - Yeongseonjetongeum BID (twice daily, 30 min before breakfast and lunch) - Gilcho-geun-dan HS (before bedtime)	1. VAS (0–10) 2. Grip and release test score - Measure the number of times the fist can be gripped and released in 10 s 3. URAM scale 4. Evaluation of satisfaction - 5-point Likert scale 5. Adverse reaction evaluation - Observing whether there are any adverse reactions such as bleeding, swelling, pain, etc.	1. 4.7 → 1.1 2. 13.5 → 19.0 3. 18 → 10 4. 5 (very satisfactory) 5. None (only minor bleeding noted)

LI, large intestine meridian; TE, triple energizer meridian; HT, heart meridian; PC, heart meridian; R, retaining time; ROM, range of motion; ICBA, I Ching Balance Acupuncture; SI, small intestine meridian; BL, bladder meridian; MCP, metacarpophalangeal joint; PIP, proximal interphalangeal joint; DIP, distal interphalangeal joint; BID, bis in die; HS, hora somni; VAS, visual analog scale; URAM, Unite Rhumatologique des Affections de la Main..

1. Classification according to the year of publication

The five studies included in this review reported case studies published in 2016 (one study), 2018 (two studies), and 2023 (two studies; Table 1).

2. Classification according to the clinicodemographic characteristics of the study participants

1) Sex and age

Among the five included studies, four reported individual cases, and one reported 16 cases, resulting in a total of 20 cases. Of these, 12 were males and 8 were females. In a study that reported 16 cases [11], the participants aged between 48 and 79 years, with an average age of 58.5 years. The remaining four studies included one participant in their 50s, two in their 60s, and one in their 70s. The average age of all the patients participating in the five studies was 59.6 years (Table 1).

2) Affected areas

Of the 20 patients, 2 exhibited bilateral symptoms, with 8 on the right side and 10 on the left side. Symptoms primarily manifest in the palms and fingers, but some patients report symptoms in more than one finger. Excluding 1 case [9] in which the affected area was unclear, 29 fingers were included in the remaining 19 cases. The ring finger was the most commonly affected ginger (14 cases), followed by the little finger (11 cases) and middle finger (4 cases; Table 1).

3) Treatment duration

Most studies have specified the exact duration and number of treatment sessions. Treatments were conducted in 1, 6, 10, 12, and 30 sessions. One study using a Pi needle [11] also reported the recovery time post-procedure, which varied from 7 to 14 days (average: 10 days; Table 1).

3. Classification according to the interventions

In five studies, various Korean medicine interventions were used, including acupuncture, moxibustion, pharmacopuncture, and warm needling. Acupuncture was used in four studies, moxibustion in two, and herbal medicine in one. Moreover, Chen and Wang [11] used a Pi needle, while Bang et al. [12] incorporated bee venom pharmacopuncture along with basic acupuncture and moxibustion. Jun et al. [13] chose warm needling, which combines acupuncture and moxibustion, as the primary intervention (Table 2).

1) Acupuncture

Four studies, excluding those conducted by Chen and Wang [11], used acupuncture as the treatment intervention. Kotlyar and Stone [10] exclusively used acupuncture techniques using the I Ching Balance Acupuncture (ICBA) method based on meridian-related theories. The remaining three studies combined acupuncture with other treatment interventions.

All four studies reported the acupoints used in the treatment. In Kim’s [9] study, the acupoints included large intestine meridian (LI)-4, triple energizer meridian (TE)-5, LI-10, heart meridian (HT)-7, and pericardium meridian (PC)-7. Kotlyar and Stone [10] used unspecified acupoints along the small intestine meridian (SI) as well as bladder meridian (BL)-65 and BL-66; Bang et al. [12] included HT-8 and four additional Ashi points; and Jun et al. [13] reported two trigger points, including HT-8.

The ICBA technique used in Kotlyar and Stone’s [10] study involved the identification of a primary treatment meridian and adding acupoints from the corresponding symmetric meridian for balance. In accordance with this theory, this study designated the right SI as the primary treatment meridian and additionally needled BL-65 and BL-66 of the left foot. Although the specific acupoints on the right SI were not stated, it is possible that they were selected from SI-1 to SI-5, which were located around the right fifth finger, depending on the area of manifestation.

The reported treatment durations in these studies were 10, 20, and 30 minutes, with one study [10] not specifying the treatment duration.

2) Moxibustion

Moxibustion was used in three studies. Kim [9] applied indirect moxibustion to the PC-8 area for 30 minutes. Bang et al. [12] applied indirect moxibustion to the same areas as acupuncture and performed the treatment twice at each site until the area began to burn. Jun et al. [13] inserted the needle to a depth of 5–7 mm, placed the moxa on top, and waited for it to burn for approximately 10 minutes before removing it, applying two pieces at each site.

3) Bee venom pharmacopuncture

Bang et al. [12] incorporated bee venom pharmacopuncture, acupuncture, and moxibustion as treatment interventions. Unlike the acupuncture and moxibustion treatments, which were administered 30 times, bee venom pharmacopuncture was performed three times a week for a total of nine sessions from December 14, 2015, to January 2, 2016. A B4-eBV solution at a concentration of 0.1 mg/mL (10%, 1:10,000) was used, and the treatment sites were the same as those used for acupuncture and moxibustion. Each treatment session involved a total volume of 0.4 mL, which was administered in four separate sites with 0.1 mL injected at each site.

4) Herbal medicine

Jun et al. [13] combined herbal medicine with warm needling as the primary intervention. Hyungbangsabaeksan as a decoction was administered at two doses per day, three times daily, for 2 hours after meals. Moreover, they used the formulated herbal medicine Yeongseonjetongeum, which was given twice daily, 30 minutes before breakfast and lunch, while Gilcho-geun-dan was administered before bedtime.

5) Pi needle

Chen and Wang [11] used the Pi needle as the primary treatment intervention. The treatment method involved selecting three to four points on the lateral side of the affected finger for incision. This procedure involves making vertical incisions in the fascial layer horizontally beneath the skin to cut through the fibrous tissue, causing contracture. Care was taken to avoid damaging the deep vessels and nerves while simultaneously assessing the degree of tension in the fascial contraction by extending the fingers and palm. Generally, incising to 3–4 sites allows the affected fingers to straighten adequately; if the palm and fingers do not fully extend, additional incisions may be made.

4. Analysis of the evaluation methods

Kim [9] and Kotlyar and Stone [10] reported only the improvement observed in patients without specifying the numerical values for pain, range of motion (ROM), or grip strength. In contrast, the remaining three studies implemented various evaluation methods to assess the posttreatment condition. Two of these studies evaluated the ROM before and after treatment as part of their assessment tools using different evaluation methodologies.

Chen and Wang [11] adopted the assessment method presented by Adam and Loynes [14], which categorizes the degree of joint contracture and extension function recovery into four grades: (1) excellent, (2) good, (3) fair, and (4) poor (Appendix 1). Bang et al. [12] assessed the contracture angles of the metacarpophalangeal joint (MCP), proximal interphalangeal joint (PIP), and distal interphalangeal joint (DIP) joints before and after treatment and categorized the results using Tubiana’s grading system. This method involves the calculation of the sum of the contracture angles for each joint and dividing it into five levels, ranging from 0° to 4° (Appendix 2).

Jun et al. [13] used five evaluation methods: visual analog scale (VAS), grip and release test score, Unite Rhumatologique des Affections de la Main (URAM) scale, satisfaction assessment, and adverse reaction evaluation.

The first method, the VAS, was used daily during the evaluation period to measure the stiffness and numbness experienced between the fourth and fifth fingers of the left hand before treatment. A score of 0 indicated no discomfort or sensations of numbness and stiffness, whereas a score of 10 indicated complete numbness and stiffness. The patients were instructed to mark their perceived levels. The second method, the grip and release test score, assessed the number of times a patient could clench and unclench their fists within a 10-second period. The third method, the URAM scale, evaluates nine items related to daily activities, such as washing the face and shaking hands. The scoring was set such that “can perform without difficulty” received 0 points, while “impossible” received 5 points, allowing for a comparison of total scores daily to assess improvement (Appendix 3). Fourth, a satisfaction assessment was conducted using a 5-point Likert scale, wherein patient satisfaction was rated on a scale from 0 to 5. This evaluation was performed at the end of all treatments (Appendix 4). Finally, the adverse reaction evaluation involved observing whether any adverse reactions, such as bleeding, bruising, hematoma, swelling, or pain, occurred following the warm needling treatment (Table 2).

5. Analysis of the evaluation methods

In all studies, improvements in symptoms were reported according to the evaluation methods (Table 2).

This study assessed the effectiveness of traditional Korean medicine in treating Dupuytren’s contracture. All included studies have shown positive outcomes in various evaluation results, such as objective indicators such as contracture angles, subjective measures of improvement, and patient satisfaction.

In a study by Chen and Wang [11], using Adam and Loynes’s [14] assessment method, 22 of 25 fingers showed 100% improvement in joint contracture and were rated as excellent, while two fingers showed more than 75% improvement and were rated as good; one finger showed no improvement and was rated as poor. Bang et al. [12] assessed the changes in the contracture angles for each joint. After treatment, the MCP contracture angle of the fourth finger changed from 70° to 50°, the PIP contracture angle changed from 70° to 60°, and the DIP contracture angle remained at 15°. For the fifth finger, the MCP changed from 65° to 50°, the PIP changed from 60° to 50°, and the DIP remained at 20°. Furthermore, these results were further categorized using Tubiana’s grading system, with both the fourth and fifth fingers changing from grade 4 to grade 3.

Jun et al. [13] performed an assessment using five methods. The VAS score improved from 4.7 to 1.1, while the grip and release test scores increased from 13.5 to 19.0 repetitions. The URAM score decreased from 18 to 10, indicating a reduction in the total score. In the satisfaction assessment using a 5-point Likert scale, a score of 5 (very satisfactory) was recorded. Finally, no adverse reactions such as bleeding or swelling were reported following the warm needling treatment. Two studies [10,11] visually documented the improvement in contracture by comparing the photographs of the patients’ fingers before and after treatment.

In a study by Kim [9], the results following treatment included decreased pain, recovery of full ROM, and improved grip strength. Moreover, Kotlyar and Stone [10] reported a complete dissipation of pain and restored ROM. However, they did not present clear evaluation criteria or numerical results following treatment, making it difficult to systematically assess the outcomes. Furthermore, Kim [9] only described the treatment area as the “right hand,” indicating a need for more specific information.

There has also been considerable discussion regarding the inclusion of the Pi needle in traditional Korean medicine treatment in one study [11]. The research defined this treatment method as “fasciotomy,” suggesting that the Pi needle might be classified as a surgical intervention. This can be explained by the following three factors. First, we used a Pi needle to incise the fascia at multiple points and cut the contracted fibrous tissue to induce therapeutic effects with minimal invasiveness. Although differences were observed in the language used to describe the method since the study was conducted in China, the technique and effects were similar to those of autotomy therapy. Moreover, the author also compared the effects of the Pi needle and traditional acupuncture therapy in the study, and “acupuncture therapy” is listed as one of the keywords in the “Abstract” section. Finally, the term “Pi” in Pi needle is derived from the Chinese character for “skin,” suggesting that it should be recognized as a method within either traditional Chinese medicine or Korean medicine. Therefore, in this study, the Pi needle was used as a Korean medical intervention.

The aim of this study is to determine whether traditional Korean medicine treatments for Dupuytren’s contracture can show positive effects compared with the conventional treatments that are currently widely used in Western medicine. Current treatment methods for Dupuytren’s contracture include CCH injection, fasciectomy, and other surgical procedures. These treatments have been proven to be effective in various studies in terms of pain, contracture severity, and patient satisfaction. However, disadvantages such as recurrence rates and postsurgical discomfort have been highlighted from various perspectives. The traditional Korean medicine treatments observed in this study demonstrated relatively noninvasive yet clear therapeutic effects. Moreover, no side effects such as hematoma or pain after the procedure were reported in any of the included studies. This suggests that traditional Korean medicine treatments, including acupuncture, moxibustion, pharmacopuncture, herbal medicine, and autotomy, can minimize side effects and provide positive effects for Dupuytren’s contracture.

However, when gathering studies on the use of traditional Korean medicine for Dupuytren’s contracture from various databases, the number of available studies, both domestic and international, was limited. Although the relatively low prevalence of Dupuytren’s contracture compared with other hand disorders, such as carpal tunnel syndrome and De Quervain syndrome, may contribute to this scarcity, further research is needed to confirm the efficacy of traditional Korean medicine in treating this condition.

In this study, we analyzed the use of traditional Korean medicine in the treatment of Dupuytren’s contracture. Methods such as acupuncture, moxibustion, pharmacopuncture, herbal medicine, and Pi needles have been used. Most patients included in the studies showed positive outcomes on various evaluations, including pain relief, reduction in the contracture angle, and satisfaction. Furthermore, the results of this study confirmed that traditional Korean medicine has a beneficial effect on Dupuytren’s contracture.

Conceptualization: YJH. Formal analysis: YJH. Investigation: YJH. Methodology: YJH. Supervision: CKL. Writing – original draft: YJH. Writing – review & editing: All authors.

The authors have no conflicts of interest to declare.

None.

This research did not involve any human or animal experiments.