Dupuytren’s Disease

Dupuytren’s Disease

What is Dupuytren’s Disease?

Abnormal thickening of the tissue just beneath the skin of the palm and fingers. Over time the scaring can draw the fingers toward the palm causing contracture and impair function of the hand. It affects men more than women and more prevalent and severe in patients of Northern European decent. (See Dupuytren’s contracture)

What cause Dupuytren’s Disease?

  • Strong Genetic component

Diagnosis

  • See your Hand Surgeon
  • Clinical
  • No genetic testing as of yet

When to see your Hand Surgeon?

When the contracture is affecting daily function. If you can’t put your hand flat on the table or having trouble putting your hand in your pants pocket. (See the Table-top test)

Treatment Options

There are currently 3

  • Needle Aponeurotomy
  • Xiaflex® (Collagenase) Injection
  • Open Fasciectomy

Needle Aponeurotomy

In clinic, the area over the diseased cord tissue is numbed up, a small 25G needle is then used as a small fine knife to cut the cord.  After the cord is weakened, the finger will be straightened with manipulation. (See Video: Dr. Zhang performing needle apponeurotomy)

After the procedure, soft dressing is applied, you can use your hand normally, and a night-time splint is provided for 3 months

Xiaflex®  injection

Xiaflex® is FDA approved medicine. It is a mixture of class I and II collagenase that weaken the Dupuytren’s cord tissue.

The medicine is injected in clinic into the cord tissue. It’s common to have an inflammatory reaction with some swelling and redness in the next few days.  You will return to clinic in a few days to one week for manipulation. At the time of manipulation, your hand is numbed up and traction is applied to break the cord.

After the procedure, a soft dressing is applied, you can use your hand normally and a night-time splint is provided for 3 months.

Open Fasciectomy

Reserved for patients who are not candidates for the other procedures. (See open fasciectomy photo)

Which one is for you?

There are pros and cons for each procedure Consult with Dr. Zhang.