By John E. Blank, MD
Dupuytren’s disease is a disorder of the connective tissue in the hand that can result in digital joint contractures. This means the fingers bend toward the palm and cannot be fully extended; making it difficult to move the hands freely.
The cause of this disease is unknown. However, the disease has a strong genetic component and is more common in people of Northern European descent.
Dupuytren’s can begin as palmar nodules, rope-like cords that can ultimately extend to the fingers and contract the joints. Skin dimpling and pitting can also occur. While painful nodules and cords in the palm can be removed, they are commonly observed until a contracture results.
Contractures of the digits can impact daily living and make it difficult for people to place their hands into their pockets, apply gloves, write, use tools, and participate in athletics. For those experiencing difficulties with daily activities, treatment may be recommended.
Historically, treatment has centered around surgical removal or excision of the diseased fascia from the palm and digits to correct the flexion contracture and improve overall motion and function. The procedures include needle placement (aponeurotomy or fasciotomy) and standard fascia removal (palmar digital fasciectomy). Advanced cases can require skin grafts, extension splinting, and outpatient hand therapy.
There is now a non-surgical option that can be performed in my office. Xiaflex, an enzyme known as collagenase, can be injected into a cord (that is resulting in a digital contracture) to break down the diseased fascia cord and restore extension to a particular joint or finger. Xiaflex injections are FDA approved and are appropriate for many of my patients. This has been an exciting advance in the treatment of Dupuytren’s disease.