Dr. Glenn Gaston
Dupuytren's contracture is a condition where the fibrous tissue in the palm of the hand thickens and patients develop what looks like knots or cords. The thickening and tightening of these cords (contracture) begin to gradually draw their fingers down in a curl, to the point where a patient has trouble uncurling the fingers. It can be functionally impairing -- simple activities such as shaking someone’s hand, putting your hand in a pocket or even just grabbing a coffee mug, suddenly become difficult. The condition is more common than people realize. One in ten Americans will have Dupuytren's contracture, so many of us will have a friend or family member affected by it.
Dupuytren's, which is thickening of the tissue under the skin on the hand, shouldn’t be confused with arthritis, which affects the joints.
Who gets Dupuytren's? It is most common in people of Scandinavian (Swedish, Norwegian, Finnish) or Northern European (English, Irish, Scottish, French, Dutch) ancestry, and can be hereditary.
Dupuytren's contracture is sometimes associated with diabetes or seizures, and most commonly affects men, though we do see it in women. Typical onset is the 50s and 60s age ranges. It can present younger, and those people affected at a younger age tend to have a more severe progression; they’re the ones that tend to have hands that are more curled or drawn down as they approach 40 or 50 years old.
Our treatment for Dupuytren's contracture has evolved a lot. As recently as two years ago the treatments we had to offer patients were an open surgery, which we do still use and is very effective, or needle aponeurotomy. One of the exciting things for us is that OrthoCarolina is one of the first centers in the country to now offer Xiaflex, a nonsurgical injection treatment that dissolves the fibrous tissue cords.
The injections have an enzyme in them that dissolves these cords by chemically breaking down and weakening them so that they can be manipulated back straight. The patient receives an injection into the cord that is drawing the finger up, then returns to our office the following day. We wait those 24 hours so the injection has time to take effect, and then we straighten the finger. Patients will feel a pop, and the finger becomes straight again. We splint it and begin motion work and therapy right away with a physical therapist. Patients literally see results the day following their injection.
We are currently tracking patients that we treated for Dupuytren's starting about a year ago, and there are other cases that show patients treated as long as 8 years ago. The results we’ve seen so far are encouraging, but there are always risks associated with any treatment or surgery.
Our hands are essential in so many daily tasks that we do. Fixing Dupuytren's contracture is one of the most rewarding things I do as a physician. I am honored to be part of a team using the latest in cutting-edge technology to treat it, as we continue to look for even better ways to get our patients back to their daily lives, even better than they were before.
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February 21, 2014