Dupuytren’s Disease
Characterized by thick cords or nodules on the palm of the hand or fingers, Dupuytren’s disease, or “Dupuytren’s Contracture”, is caused by the buildup of collagen and development of new tissues in the hand. Dupuytren’s is most common in Caucasian men with a Northern European or Anglo-Saxon background as well as anyone with a family history of the disease.
What are the symptoms of Dupuytren’s Disease?
Dupuytren’s disease is usually painless. The early signs of the disease include painless, firm nodules in the palm. As the disease progresses, the nodules turn into cords in the palms, which can ultimately lead to joint contractures where the fingers begin to bend in towards the palm and are unable to be extended. The fingers most commonly affected are the ring and pinky fingers and the joints most commonly affected are the metacarpophalangeal and the interphalangeal joints.
When the joint contractures, or shortening and hardening of the tissue, occurs for a period of time it can lead to contractures of the skin, tendons, and ligaments around the affected joints. As a result, people have trouble grasping objects and the flexed finger(s) can get in the way when using their hand.
What is the treatment for Dupuytren’s Contracture?
Several treatments are available for Dupuytren’s disease, both surgical and non-surgical.
There are currently two non-surgical treatments; Needle Aponeurotomy and Collagenase Injection (Xiaflex).
Needle Aponeurotomy: This is a non-surgical, office procedure where a needle is used to make multiple passes through the abnormal tissue in the palm to weaken it. Then, the Dupuytren’s cord can be ruptured. This procedure does not remove the diseased tissue but can be repeated if needed. It is most appropriate for patients with a small area of disease or those who cannot undergo surgery. This procedure is now being replaced by Collagenase injections known as Xiaflex injections.
Collagenase injection (Xiaflex): Xiaflex is another non-surgical, office procedure where an enzyme is injected into the diseased tissue. The enzyme breaks up the collagen in the cord, allowing the fingers to be extended after 24 hours. The risks of this procedure are minimal, and include bruising, numbness, and allergic reaction. Some patients require more than one injection for complete release. The enzyme is usually covered by insurance. Patients often find this treatment more convenient than surgery. After the procedure, patients often undergo a short course of splinting and hand therapy. The procedure has a high satisfaction rate.
With needle aponeurotomy and collagenase injections, there is a chance that symptoms may return because both treatments do not remove the diseased tissue.
The third treatment is Surgery. Upon making the diagnosis, surgery may not be recommended immediately if the nodules or knuckle pads are isolated and do not interfere with hand function.
Surgery: Surgery is indicated when there is loss of function or progression of the disease. The loss of function usually results from contractures in one or more of the three finger joints. During surgery, the doctor removes the scarred tissue to free the fingers and release the tendons. Patients whose main concern is cosmetic, meaning they are unhappy with how their hand looks due to the disease, are discouraged from having surgery.
The recurrence rate for both needle aponeurotomy and collagenase injection may be higher than surgery, as the diseased tissue is not removed.
If you are experiencing any of signs or symptoms of Dupuytren’s Disease, we recommend scheduling an appointment with one of the hand specialists at Advanced Specialty Care in Danbury, New Milford or Ridgefield, CT to discuss concerns and possible treatment options.