The human hand is amazing in its versatility. We use our hands for big and small work, to express our emotions and communicate with others. Our quality of life can suffer when our hands don’t function as well as they should.
Dupuytren’s contracture (sometimes called Dupuytren’s disease) is a very common condition that can affect daily living. Perhaps you’ve never heard of it, but chances are you’ve seen people who have it. It is estimated that 7 million to 14 million Americans have Dupuytren’s contracture. It causes constant contraction in the hand and eventually, the fingers (particularly the ring and pinkie fingers) bend towards the palm until they cannot be straightened and become useless.
No one knows what causes it; however, it appears to be hereditary, affecting people of Northern European descent. Smoking, alcoholism and diabetes also increase the risk.
It’s actually the connective tissue under the skin that’s affected by the condition. In its early stages, knots, or nodules will develop on the palm. Over time, usually several years, the tissue becomes a thick, tight cord, pulling the fingers down.
While the condition is not particularly painful, there is no cure. Stretching, heat therapy and steroid injections may alleviate the symptoms for awhile, but until recently, surgery was considered the best treatment.
Baron Guillaume Dupuytren, (hence the name) first described an operation to correct the affliction in 1831. During the procedure, the thick tissue is removed but it can sometimes be separate the tissue from the skin.
I had the surgery eight years ago after my condition became so severe it was difficult to put on surgical gloves — it was interfering with my profession. The results were good — I could use my hand again, but I still have some bending and a lot of scarring.
Earlier this year, the Food and Drug Administration approved the first drug treatment for Dupuytren’s contracture. The medication, called Xiaflex, is injected into the tight cord that’s pulling on the fingers. It actually dissolves the fibrous tissue allowing the fingers to straighten.
It’s a two-day treatment: the injections are done the first day, and then the patient returns to the office the next day for a specialist to do the extension. The treatment is not yet widely available. Only physicians specially trained in the procedure can get the medication. I am one of the first in the area providing the treatment.
Studies on the treatment have been very promising. In one study, nearly two-thirds of the patients treated with Xiaflex had improvement. Of course, the treatment is not a cure, but the recurrence rate for patients treated with Xiaflex was significantly lower than for patients treated with surgery. And while not everyone is a candidate for the injections, it does give physicians another option in treatment.
