If you find it difficult to extend your fingers to grasp a golf club, tennis racket or steering wheel, you may have Dupuytren’s contracture, a progressive disease that causes the fingers to curl in toward the palm. Without treatment, the affected fingers won’t be able to be straightened, and you may have a hard time typing at a keyboard, turning a door knob or placing your hands in your pockets.
While Dupuytren’s contracture affects all age groups, it is most common in men between the ages of 30 and 60. It often begins as a thickening of the skin on the palm, followed by the formation of nodules or tissue cords under the skin that extend to your fingers. As the cords tighten, you may find that your fingers are being pulled toward your palm, usually starting with the pinkie or ring finger.
Traditionally, surgery was the only option to release the cords of tissue so that the fingers could relax and return to a more normal position. But now there is a new medical treatment that can dissolve the abnormal growth of collagen, a protein found in connective tissues, and achieve positive results in many patients with Dupuytren’s contracture.
Now, patients can receive injections of XIAFLEX® (collagenase clostridium histolyticum) a bioengineered enzyme made by Auxilium Pharmaceuticals in a simple outpatient procedure. Patients return to the office the next day, after the enzyme has had time to work. In most cases the curled fingers can be manually straightened – sometimes with an audible “snap” as the cords are released. If the fingers have been “frozen” in position for some time, there may be tears on the surface of the skin, but most patients heal quickly.
For patients who have been affected by Dupuytren’s contracture for a long period, surgery may still be the best approach. An orthopedic surgeon removes the abnormal tissue the palm and affected fingers in a procedure called a partial or a total palmar fasciectomy. It generally takes about two weeks for the incisions in the hand to heal, followed by a rehabilitation program to regain control of their fingers.
If you are experiencing signs of Dupuytren’s contracture, such as a stiffness, numbness or curling of the fingers, it is important to talk with your primary care doctor or see a specialist. Even though this condition is painless, it is much better to be treated at an early stage before it becomes more difficult to straighten the fingers. Since Dupuytren’s contracture can often be corrected with a simple injection that is usually covered by insurance, there’s no reason to delay seeking treatment.
Christopher R. Sforzo, M.D., is a board certified orthopedic surgeon with Sforzo | Dillingham Orthopedics in Sarasota who is fellowship trained in hand to shoulder surgery. He focuses his practice on problems involving the shoulder, arm, elbow, forearm, wrist and hand. He is a special consultant for IMG Academies and the Nick Bollettieri Tennis Academy in Bradenton, FL, director of sports medicine for the Premier Sports Campus in Lakewood Ranch, FL, the official orthopedic surgeon and hand surgeon to the Sarasota Orchestra, and an assistant clinical professor at the Florida State University College of Medicine, Sarasota Campus. For more information, visit www.fossm.com