What is Dupuytren’s contracture?
Dupuytren’s disease is better described as a condition that results from abnormal growths that can occur in the palm of the hand. The myofibroblast is a normal occurring cell that is found in the palm. This cell helps anchor the skin on the palm which is why that skin is not loose like on the back of the hand. In Dupuytren’s, an abnormal signal is sent to these cells resulting in abnormal proliferative growth. This abnormal growth can then because growths described as nodules and cords. We do not know why this occurs, but we believe there is a genetic component to it. This is confirmed by the fact that Dupuytren’s is more common in people of Northern European descent and men. One nickname for Dupuytren’s is Viking Disease. Dupuytren’s can also be seen on the abdomen, soles of the feet and penis (Peyronie’s Disease).
Diagnosing Dupuytren’s Contracture
Dupuytren’s presents gradually with nodules typically near the ring and small finger. Over time, cords can develop that cause contractures of the fingers. As the fingers draw down, the hand may lose function. Most people complain of difficulty fully straightening their fingers and difficulty with activities like putting their hand in their pocket. Dupuytren’s is typically not painful.
Because it is not painful, patients can live with Dupuytren’s for quite some time. Dr. Kavi Sachar encourages patients to seek consultation early for evaluation and education. The more severe the contracture, the harder it is to treat. Patients can often be observed until they cannot lay their hand flat on a table. We call this the tabletop test.
Non-Surgical treatment of Dupuytren’s contracture
Treatment for Dupuytren’s disease revolves around eliminating the contracture. Therapy may help with stretching but usually is not powerful enough to break the contracture.
One newer treatment is injection with Xiaflex. This is a medication that helps dissolve the contracture in the area it is injected. Sometimes multiple areas are injected. This is done in the office and is nonsurgical. Several days after the injection, the finger is manipulated and as the Dupuytren’s dissolves, the finger is straightened. This can be a very successful procedure in certain cases. Not all patients are candidates for Xiafex so evaluation is necessary. It is important to be evaluated by Dr. Kavi Sachar to determine if you are a candidate for Xiaflex injections. There are many factors that determine who is a good candidate for Xiaflex. Patients cannot be on blood thinners. The Dupuytren’s cannot be past the PIP joint or middle knuckle of the finger. There must be distinct cords. Dr. Kavi Sachar can inject multiple digits if they qualify for injection. Xiaflex can cause damage to surrounding tissues so precision is required when injections are performed. Xiaflex does not cure the condition but it does dissolve the Dupuytren’s in the injection which may allow the finger to straighten out. It is important to understand that the disease process continues and new Dupuytren’s can grow back in the area injected or other fingers may begin or continue to contract. Dr. Kavi Sachar has extensive experience using Xiaflex as his previous clinic was one of the national test centers when Xiaflex was first introduced. He will be able to determine if you are a good candidate and can help discuss this and other treatment options.
Needle aponeurotomy is another minimally invasive technique. An 18-gauge needle is used under a local anesthetic to cut the cords without surgical incisions. This is done as an outpatient and recovery and be very quick. Again, not every patient is a candidate for this procedure, so evaluation is necessary. Multiple fingers can be done at the same time. Dr. Kavi Sachar has extensive experience with needle aponeurotomy and can help determine if you are a good candidate.
Surgically treating Dupuytren’s contracture
Surgical removal of Dupuytren’s disease is a commonly performed procedure. The visible cords and nodules are removed in an outpatient surgery. Therapy is started soon after and most patients resume normal activities within 3-5 weeks. The advantage of surgery is it has the lowest recurrence rate. Although the therapy and rehabilitation are more involved, patients typically recover well and are happy with their results.
Recovering from Dupuytren’s contracture treatment
The important thing to remember about Dupuytren’s is no treatment is curative. The condition still exists, and growths can occur even after treatment. Most patients, however, do not require multiple surgery’s or injections. Dr. Kavi Sachar can guide you through the treatment and rehabilitation process as he has extensive experience treating Dupuytren’s contracture.
Schedule a consultation
Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on Dupuytren’s. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from Dupuytren’s, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.
At a Glance
Dr. Kavi Sachar
- Specializing in Hand, Wrist, & Elbow Surgery
- Board Certified Orthopedic & Hand Surgeon
- Consultant to the US Ski & Snowboard Team & Colorado Avalanche
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