Dupuytren’s Disease
Non surgical – Collagenase (Xiapex)
An injection is given into the cord. Another visit to the hospital the following day will allow the Hand Surgeon under a local anaesthetic to ‘break’ the cord.
Currently, it is best used for the nonoperative treatment of an isolated cord associated with a flexion contracture of the metacarpo- phalangeal joint or the first knuckle of the hand.
Currently there are no proper trials comparing it to surgery but results are encouraging in specific circumstances.
Did you know!
name. Rather he was the first to give detailed report on the subject in 1831. Previously Felix Plater in 1614 and also Henry Cline in 1777 had mentioned the disorder.
What may I notice or complain of?
Daily activities may become affected.
You or your friends may complain that you have an awkward or ‘funny’ hand shake because of the flexed or bent finger
Your finger may get into the eyes or noses when bathing or having a shower
You may find yourself dropping objects such as coins.
And even putting your hand into pockets and restricted spaces may be awkward because of the bent finger.
Sports such as golf may be affected.
You may find that it is not possible to place the palm of your hand flat on a table. When this happens, it implies a flexion contracture or ‘tightness and bend’ of the joints in the finger. This suggests urgent treatment as the flexion contracture of the middle joint (proximal interphalangeal joint)is difficult to correct especially when prolonged. It is best to treat before the patient develops this.
Some patients may also notice lumps or swellings on the soles of their feet
Others may notice an abnormal curvature of the penis (chordee) on erection.
How is it treated?
The main stay of treatment is surgery and this is to control it rather than cure the condition. The extent of the surgery is discussed at the consultation. It will usually involve the division (fasciotomy) or removal (fasciectomy) of the diseased tissue and closure with zig zag incisions (Z plasty) with or without skin grafts.
Anaesthesia
The surgery is usually performed using regional anaesthesia (brachial block). Local anesthetic is injected into the armpit and this makes the whole arm numb and surgery is performed while patient is awake. It can also be performed under general anaesthesia. Very minor cases can even be done with a simple injection in the wrist to make only the hand numb. This is discussed at the consultation.
What to expect post operatively?
Stiffness may occur and would usually respond to sustained hand therapy (physiotherapy).
Scars may be swollen and firm for a few months. Massaging the scars with moistuirising cream will help soften them.
What are some of the problems that may arise?
Infection can occur as with any surgery and is usually treated with antibiotics.
Collection of blood under the skin (haematoma) can occur especially in patients on aspirin or warfarin. It can usually be drained without much difficulty.
Minor wound breakdown is not unusual. Simple dressings will suffice.
Partial or total loss of the skin grafts or the flaps (Z plasty) may occur especially in smokers
Scars especially from skin grafts may become hypertrophic or lumpy. Massage with cream or silicone gel treatment may help. There are also scar treatments performed by the hand therapist.
There may be a tendency of the finger to bend into flexion due to the contractile forces of the scars. This is made worse if there is a lot of swelling and patient is not compliant with hand therapy. So it is important for patients to wear their splints especially at night.
There may be some areas of altered sensation or numbness on the fingers consistent with neuropraxia or bruising of the nerve. This usually recovers in a few days but may be prolonged. This will persist to a variable extent when there is a severe damage or division of one of the nerves in the finger, This is more likely in patients with repeated operations
Very few patients may react abnormally to surgery and develop a condition called complex regional pain syndrome which can cause pain and stiffness of the fingers. The aim is to detect the early signs and treat it before it becomes a major problem.
What problems may arise from an injection of collagenase?
What are the chances that other members such as the children will develop dupuytren’s disease?
The presence of one or more of the following risk factors increase the chances:
- early age of onset (below 40yrs)
- positive family history in a first or second degree relative
- presence of deposits outside the palm (ectopic deposits) – knuckle pads over the proximal interphalangeal joints, soles of the feet, penis
- presence of bilateral disease – both hands
- More than one finger involved in one hand.
Is it caused by work?
The figures are however not significant.
Is it caused by hand injury?
When to refer?
Do you know about Peyronie’s disease?
Before and After!
