Treatment offers help with Dupuytren's disease

Contributing ColumnistMarch 17, 2014 

Dr. Einbecker, Baptist Health

MIKE NILES — Herald-Leader Buy Photo

Dupuytren's disease is a disorder of the palmar fascia, the tissue under the skin of the palm of the hand. The condition, which causes the fingers to pull or contract, is named after Guillaume Dupuytren, who first described it in detail in 1831.

Up to 20 million Americans are affected by Dupuytren's disease, which is thought to be passed on genetically. Age and environmental factors seem to trigger the disease.

Men are more likely than women to be affected by Dupuytren's disease, though in later years, the incidence rates approach the same for both sexes. The older you are the higher the incidence. The disease can also affect the soles of the feet and the penis.

Dupuytren's disease affects the hands in different ways. Some will have only small, hard bumps in the palm which may occasionally be painful but usually will subside with a little time. In others, the disease forms bands or cords in the palms or fingers which are usually not painful but may start to contract, pulling the finger or fingers toward the palm.

No type of splinting or exercises has been found to alter the course of the disease. As time goes on, the fingers will draw down. It is important to get the correct diagnosis so you can monitor the progression. You should consider treatment when the finger contracture progresses to 20 to 30 degrees, or sooner if the contracture is causing problems with the activities of daily living. The greater the degree of contracture, the more difficult the disease is to treat.

Surgery is the most widely used method for treatment, but it has risks. A relatively new, non-surgical treatment shows great promise and doesn't require a long rehabilitation or hospital stay. An injection with a collagenase (enzyme) type of drug called Xiaflex will essentially dissolve the cord, causing the fingers to relax.

The physician who gives you the injection will see you about 24 hours after the injection, at which time a gentle manipulation of the finger is performed. The finger is usually straighter in most individuals. The physician may have you wear a nighttime splint for a short period of time.

Unfortunately, there is no cure for Dupuytren's disease. Not all patients are candidates for the collagenase injections, but those who are will find it a less invasive alternative to surgery.

Dr. Mark Einbecker, an orthopedic hand surgeon with Kentucky Orthopaedic & Hand Surgeons, practices at Baptist Health Lexington.

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