Dupuytren’s contracture is a painless, thickening and tightening of the fibrous tissue that leads to curled fingers. This condition affects the fibrous tissue layer underneath the skin of the palm and fingers and is more common in men than in women.
The Cause
The cause of Dupuytren’s contracture is unknown but doctors know that it is not caused by an injury or heavy use of the hand. There are some factors that are associated with this condition, however. These include Northern European descent, heredity, alcohol consumption, and advancing age.
The Symptoms
The symptoms of Dupuytren’s contracture occur very gradually. Nodules form in the palm area and are often tender. These nodules may thicken and contract, leading to a tough band of tissue under the skin. One or more of the fingers bend forward toward the palm in a flexed position. The ring finger and little finger are the ones most commonly affected but any of the fingers can be involved. This flexed position makes it difficult to straighten the affected fingers and grasping objects becomes difficult.
The Treatment
One currently used treatment for Dupuytren’s contracture is an enzyme injection called XIAFLEX®. This is administered by Dr. Weil. Basically, the enzyme is able to break down the tough bands to allow for improved motion without surgery. This procedure is performed at the orthopedic office and results are fairly comparable to surgical treatment.
The doctor will inject the XIAFLEX® directly into the diseased tissue. Over the next 24 hours, the enzyme breaks down the contracted tissue. The following day Dr. Weil will perform a manipulation of the contracted finger in order to straighten the finger. This injection is approved by the FDA and early results are promising.
Before you receive XIAFLEX®, be sure to tell your doctor if you have an allergic reaction to a previous injection or anesthetic. Also, inform your orthopedic specialist if you have a bleeding problem or are on medications that increase bleeding. Common side effects to this enzyme include swelling at the injection site, hand swelling, bleeding, bruising, pain, or tenderness at the injection site or hand, lymph node swelling, and pain of the underarm area.
Needle aponeurotomy is another great procedure that Dr. Weil performs. After numbing the hand with a local anesthetic injection, Dr. Weil uses a hypodermic needle to divide the diseased tissue. Then a manipulation of the contracted finger is performed in order to straighten the finger. This procedure is performed in the office and generally takes about 30 minutes.
It’s a minimally invasive procedure and patients experience less pain and swelling when compared to surgery and early results are comparable to XIAFLEX® and to surgery.
Surgery for Dupuytren’s contracture remains the gold standard treatment and is usually reserved for the most severe cases. It involves making a series of zig zag incisions in the palm and fingers and the diseased tissues are excised from the palm. Surgery is usually performed under a regional block and as a day surgical procedure. Significant post operative hand therapy and splinting is also utilized for severe cases.
