Dupuytren’s Blog: “I’ve Got One Hand in My Pocket.”

There are many conditions and diagnoses that medical professionals come across in their careers. Some are more common than others and some are only seen once in a career. One of the common conditions that we see in our clinic is a hereditary condition known as Dupuytren’s contracture. If you are not part of the hand therapy world, this condition may not ring a bell, unlike Pavlov. However, we see this condition on a regular basis. Dupuytren’s contracture is more formally known as palmar fibromatosis. It occurs when there is a shortening or thickening of the palmar fascia which can lead to a finger flexion contracture. Some people mistakenly think that the tendon is being contracted when in reality it is the palmar fascia. What is palmar fascia, you ask? Palmar fascia is a thick mesh of fibrous tissue that lies under the skin, but lies on top of the tendons, muscles, and bones of the hand. When Dupuytren’s attacks this fibrous tissue, cords of fascia thicken and can even form nodules. As the disease progresses, the finger is brought into more and more flexion. The cord is unable to be stretched out, so the finger is unable to fully extend. Some practical difficulties that arise as a result of this condition are the inability to lay the hand flat on a table, difficulty putting the hand into the pocket of one’s pants, and difficulty/awkwardness when shaking hands with others.

So, how does one get Dupuytren’s contracture? The condition is also referred as the Viking’s disease because most cases are from people of northern European descent. The disease affects men more than women and normally appears after the age of 40. Persons with diabetes are at an increased risk of developing Dupuytren’s. The condition is a hereditary one and cannot be contracted from another person. Fortunately, Dupuytren’s is typically not a painful condition. The most commonly affected fingers seen in our clinic are the ring and small fingers. However, any finger can be affected by Dupuytren’s including the thumb. Treatment for the condition is normally not sought after or recommended until the finger flexion contracture is affecting your everyday function.

So, what treatment is available? Currently, there are 3 primary options to treat Dupuytren’s. The most common is called a palmar fasciectomy. This procedure involves the removal of the affected fascial tissue via an open surgery. The nodules are removed, and the finger is able to extend within a functional range. The hand surgeon will surgically open the palm in a zig-zag fashion to perform the procedure. Within the first week following surgery, an extension splint is fabricated by your hand therapist and therapy is begun in order regain motion. Sutures are removed approximately 2 weeks following surgery. Another procedure to address Dupuytren’s is a needle aponeurotomy. The procedure is minimally-invasive. A needle is placed under the skin into the affected fascia. The needle cuts or breaks the cord thereby allowing the finger to extend. Again, within the first week following the procedure, the patient is placed into a custom extension splint and therapy is begun.

A third treatment for Dupuytren’s is a Xiaflex injection. Xiaflex is an enzyme that breaks down the collagen in the affected tissue. After the Xiaflex injection is administered into the cords, the patient is sent home. Once the patient returns 24-48 hours later, the physician performs an in-office manipulation to break the cord thereby allowing the finger to extend. This procedure can be painful, but typically does not require sutures. In some cases, skin tearing occurs that requires some wound care. Patients are often placed in a custom splint and begin therapy following the procedure. However, some physicians do not prescribe therapy following this procedure. Patients have found success via all three options. Each procedure has its advantages and disadvantages. In terms of conservative treatment options, such as therapy, the research is not strong to support the effectiveness of treating Dupuytren’s prior to one of the three aforementioned interventions. However, maintaining available range of motion is always a good idea, no matter what the condition. If you would like to learn more about any of these procedures or have other general questions related to Dupuytren’s or other hand related conditions, you may reach out to Oliver or David at (469) 664-0026.

 

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