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Dupuytren's Disease

Dupuytren Hand Disease Pic
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Added on January 24, 2017

By Ildiko Paulovits, OTR, CHT/ PT Staff – Westfield

Have you ever noticed a bump or a dimple at the base of your fingers in your palm? It could be Dupuytren's Disease and there are multiple treatments available. Dupuytren's affects the fascia of the palm and can progress from lumps and dimples to a cord that causes a contracture (where the fingers are pulled down into the palm). Should the contractures progress it can affect daily function and make shaking hands, getting change out of your pocket and even writing difficult.

The various treatment options include surgical removal of the affected tissue, needle aponeurotomy and injection with collagenase clostridium histolyticum (Xiaflex). You need to visit a board certified hand surgeon to explore which option is the right one for your hand.

Surgery can involve incisions that extend from the palm to the middle of the affected finger/fingers and will take months to heal from and regain motion and strength. There is extensive therapy during the recovery period. Some Dupuytren's cords require surgery and cannot be managed non-surgically.

Needle aponeurotomy is usually done in the doctor's office and involves getting the hand/fingers numb and the surgeon uses a needle under the skin to break the cord. It is done in one treatment and the follow up usually includes a night orthotic to maintain the gains in finger extension and possibly therapy.

Treatment using Xiaflex begins with an office visit to inject the drug into the cord in the palm. At this time surgeons are not injecting cords that extend into the finger. There is too high a risk for complications. The drug continues to work overnight and into the next day when the patient returns to the doctor's office to complete the procedure. The hand is numbed and then the cord is broken by the physician. Follow up includes night time use of the orthotic to maintain the extension gained during the procedure.

Treatment has changed over the years and there are more options available for treatment sooner in the disease process. Most certified hand therapists can recognize if the process has started and refer you to a board certified hand surgeon. So if you see a lump or cord in your palm, make an appointment with a hand specialist to start exploring your options for treatment.





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