Dupuytren’s Contracture is a physical disorder of the hands which restricts complete straightening of the fingers. The tissue layer beneath the skin may get thickened into clots which pulls the fingers towards the palm. The condition may have a severe effect on the day-to-day activities of the patient, such as lifting objects. Also, known as Viking’s Disease, it is most commonly observed in the ring and little finger. The disorder has a slow level of progression and often does not cause any serious problems.
A hand deformity that usually develops over a number of years, Dupuytren’s disease (or Dupuytren’s contracture) affects more than 200,000 individuals per year.
Causes
- Hereditary factors
- Excessive alcohol consumption may be a potential cause
- Diabetes
- Seizures may result in such abnormalities
- Aging
- Smoking increases the risk of developing the condition
While many believe that Dupuytren’s disease arises due to hereditary or genetic factors, certain risk factors may also play a role in disease development. Risk factors include:
- Age – Typically Dupuytren’s disease starts to show symptoms when an individual reaches middle age
- Gender – Doctors observe Dupuytren’s disease in men more often than women
- Family descendants – Doctors typically observe Dupuytren’s disease in those with Northern European backgrounds. Many believe Dupuytren’s disease to have genetic factors.
- Medications – Studies have shown a link between Dupuytren’s disease and certain medications commonly used to treat seizures.
- Having a history of poor nutrition or diabetes
Symptoms
- Presence of thick lumps or nodules under the skin of the palm. When pressed, these lumps may feel tender but do not cause pain
- Difficulty in grasping objects
- Fingers may be flexed towards the palm
- Limited range of motion
- Irritation and burning sensation may occur, in case of inflammation of the tendons in the hand
- Pits in the skin pinched from the contracted finger
- Inability to lay hand flat onto a flat surface
Diagnosis
- Clinical evaluation of the affected hand may reveal the presence of Dupuytren’s Contracture
- Palpation may be done to assess the thickened tissue cords beneath the palm
- The doctor may check the range of motion of the hand
- Specific devices may be used to measure the level of contracture
Treatment
A variety of treatment options exist for treating Dupuytren’s disease. Treatment of Dupuytren’s disease can range from doing nothing to conservative treatment or surgery. The best treatment for each individual may vary and depends on the location of the cords and nodules and the severity of the contractures.
- Enzyme Therapy – Injecting some specific enzymes (collagenase) into the soft tissues of the hand may provide relief and improve motion as it dissolves the thickened cords
- Corticosteroids may be injected to arrest the progression of the disease
- Needle Aponeurotomy – a needle may be used to puncture the thickened tissue cords and manual manipulation may be done to straighten the fingers.
- Radiation therapy
- Surgical correction of the tissues may be required if the condition progresses rapidly. In the procedure, the doctor may remove the lumps and perform skin grafting to close the wound.
- Post-surgery, the patient may be advised to keep the affected hand elevated to prevent swelling.
- Physical therapy may help to restore strength and flexibility of the hand and fingers.
Dupuytren’s Disease and Xiaflex
A collagenase used for the treatment of Dupuytren’s contracture, Xiaflex remains a popular treatment option. A type of proteins that perform functions, enzymes reduce the energy requirements of a chemical reaction. A collagenase enzyme, Xiaflex breaks down the structure of collagen at the molecular level. Patients should always seek out the care of a board-certified orthopedic hand specialist to use Xiaflex. The orthopedic hand specialist injects the collagen knot or cord within the hand with the Xiaflex which breaks down the excess collagen in the area, therefore eliminating or decreasing the size of the knot.
Why Choose a Xiaflex Collagenase Injection for Dupuytren’s Contracture
Orthopedic hand specialists use collagenase clostridium histolyticum (brand name XIAFLEX) enzyme injections to treat Dupuytren’s contracture. The enzyme dissolves a small portion of the thick cord allowing the physician to straighten the finger. The treating physician dictates whether or not a patient should receive Xiaflex. Xiaflex may not work on every patient and doctors can utilize other treatment options. A non-surgical resolution for the treatment of Dupuytren’s contracture, Xiaflex injections work to restore mobility to the hand without a painful surgical recovery.
What to Expect With a Xiaflex Injection
When seeking treatment for Dupuytren’s contracture (or disease), patients should seek care from a board-certified hand and wrist specialist. The doctor begins with a physical examination of the patient. The doctor goes over all medical history and daily activities. The doctor may perform physical tests on the affected hand but many can visibly see the knot or cord after simply looking at the hand. To rule out any other issues within the hand, the physician may order diagnostic testing. Once the doctor diagnoses the patient with Dupuytren’s disease, the physician discusses treatment options. If the doctor determines Xiaflex can help the patient, the physician must work to get the insurance company to help pay for the injection. Getting the insurance company to give approval for use of the enzymatic treatment remains the greatest hurdle in the treatment of Dupuytren’s disease using Xiaflex. Although Xiaflex has been on the market for a fair amount of time, the price has remained on the higher end of available treatment options. Once approved, the treatment takes place in the office of the physician.
To start the procedure, the doctor numbs the hand so the patient does not feel pain. The hand specialist places the injection into the thick cord that causes the finger to contract. The night after the injection, the hand may bruise and swell. Between one and three days following a Xiaflex injection, the patient must have a clinic follow-up with the treating physician. During the follow-up visit, the physician checks the injection site. After applying a numbing agent, the physician then straightens the finger. The weakened collagen cord snaps when the doctor manually straightens the finger and restores the flexibility of the hand.
Each physician differs but in most cases the treating physician prescribes a physical therapy protocol. Physical therapy helps the patient strengthen the hand and maintain flexibility so the finger does not contract again.