Exciting New Advancements in the Treatment of Dupuytren’s Disease – Xiaflex, Needle Aponeurotomy, or Surgery

Dupuytren’s Disease – What is it? 

Dupuytren’s contracture is an abnormal  thickening of the tissue just beneath the skin of the hand. You may notice thickening, pitting of the skin of the palmar skin and often the fingers can become contracted, making simple tasks difficult such as placing the hand flat on a table or placing a hand in a pocket. 

Usually, the condition is painless, though occasionally the initial presentation is accompanied by pain and inflammation. It is important to note that the underlying tendons and nerves are not directly involved, however, the nerves and vessels often become entrapped in the contracture, making treatment difficult.

Dupuytren’s Demographics

Fortunately, there are several exciting new treatments in the treatment of Dupuytren’s contracture.  I will describe the treatments in detail shortly, but in short, the cords need to be released if the finger is to be straightened.  The usual patient with Dupuytren’s contracture is over 40 and of Northern European descent. There is usually no associated injury or occupational exposure and the likely cause of Dupuytren’s contracture appears to be genetic.

Dupuytren’s Symptoms

The ring and small fingers are most commonly affected, with lumps and pits in the palm and progressive contracture of the hand. The cords often feel like tendons and usually hand function is unaffected until the fingers become curled. Initially, the nodules can be painful, but this usually resolves. Unfortunately, progression of the disease is unpredictable.

State of the Art Treatments for Dupuytren’s Contracture

At Orthopedic Specialists of Seattle, we offer all of the state of the art treatments for Dupuytren’s disease. First and foremost, a proper diagnosis is essential and usually I can help rule out other conditions, such as trigger finger, arthritis, or other similar conditions.

Traditional treatments include surgical resection of the diseased fascia. This is nearly universally successful for the resolution of the contracture, which is quite rewarding. The downsides to open resection include need for surgery, extensive rehabilitation, and a moderate recurrence rate of 10-15%. I perform this surgery routinely with excellent results.

Xiaflex injections are also an exciting new treatment which consists of injection of the cords with an enzyme which breaks down the cords over the course of 24-48 hours, allowing for manipulation of the fingers into a straightened position. The downsides currently are the cost ($3000/injection) and again, the recurrence rate higher than that of open surgery. We at the Orthopedic Specialists of Seattle offer Xiaflex injections.

Finally, there is an in-office procedure called a needle aponeurotomy, which is an impressive, relatively painless procedure where I am able to disrupt the cords in a single office visit.  This procedure has relatively small costs, is relatively straight forward and successful in my hands.  The downsides are simply the recurrence rate, again somewhat higher than open surgery.

If you are interested in this procedure, it is worth letting our front office know that they should set up a double appointment, to allow for the possibility of performing the procedure on the same office visit. It might be worth sending me a note explaining your condition and I can help facilitate a reasonable amount of time for your visit

If you have Dupuytren’s disease and would like to discuss your contracture, do not hesitate to call 206-633-8100 or contact me.

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About Scott D. Ruhlman

Scott D. Ruhlman, MD Dr. Ruhlman offers the highest quality specialty care of hand, shoulder and elbow disorders. In addition to caring for such disorders in both the child and the adult, Dr. Ruhlman offer state-of-the-art fracture care, sports medicine and joint replacement surgery of both the upper and lower extremities.