Houston Dupuytren’s Contracture

PALM RELATED DISORDERS

A hand condition affecting the connective tissue of the palm, Dupuytren’s Contracture causes hand deformity, loss of finger function and hardening of the affected area. A rare condition, Dupuytren’s Contracture is not generally painful, but can make everyday activities such as straightening the fingers, shaking hands and putting hands in pockets more difficult. The condition generally progresses slowly over the course of several years. In some cases, however, it can progress fairly steadily over the course of several months. Though the cause of this condition is not fully known, possible contributing factors include family history, alcohol and tobacco use, and Diabetes.

Symptoms

• Thickening of skin on palm
• Formation of a lump beneath skin
• Cords of tissue form
• Difficulty straightening ring and pinky fingers

Diagnosis

Testing and diagnosis entails a physical examination of the hands, including evaluating their look, feel and range of motion. A test of one’s ability to flatten the hand palm-side down on a flat surface is often used for diagnosis.

Treatment

In some cases, the condition may not progress enough for treatment to be needed. In other instances, surgical or non-surgical treatments may be necessary to relieve the symptoms. Non-surgical options include steroid injections. Surgical treatment often entails removing or dividing the banded tissue to restore finger mobility. Surgery is reserved for cases in which the fingers are unable to be extended fully. Historically, the skin and all of the diseased tissue was excised and it was necessary to have skin grafts. This is not necessary and rarely (if ever) performed. Today most surgery is through smaller incisions and focuses on removed the diseased fascia (connective tissue). As it is not a cancer, achieving a healthy rim of surrounding tissue is not necessary.

Recently approved for Dupuytren's is Xiaflex (Collagenase). It is an injectable, NON-SURGICAL treatment. The treatment involves an injection about the cord followed by a manipulation of the contracted joint the following day. Most patients have the contracture corrected to 0-5 degrees with 1-2 injections.