Dupuytren’s contracture is an abnormal thickening of the tissue just beneath the skin. This thickening occurs in the palm and can extend into the fingers. Firm pits, bumps and cords (thick lines) can develop and cause the fingers to bend into the palm (as seen above). This condition may also be known as Dupuytren’s Disease. Occasionally, the disease will cause thickening on top of the knuckles or cause lumps and cords on the soles of the feet (plantar fibromatosis).
The cause of Dupuytren’s contracture is unknown. The problem is more common in men, people over age 40 and people of northern European descent. There is no proven evidence that hand injuries or specific jobs lead to a higher risk of developing Dupuytren’s contracture. The incidence of Duputren’s contracture in the United States is 3% in white. In Norway, the incidence is about 30% to 40%. The lumps can be uncomfortable in some people, but Dupuytren’s contracture is not typically painful. The disease may first be noticed because of difficulty placing the hand flat on a surface. See picture. As the fingers are drawn into the palm, it may be more difficult to wash hands, wear gloves, shake hands, and get hands into pockets. It is difficult to predict how the disease will progress. Some people have only small lumps or cords while others will develop severely bent fingers. The disease tends to be more severe if it occurs at an earlier age.
Before & After
In mild cases, especially if hand function is good, only observation is needed. A lump in the palm does not mean that treatment is required or that the disease will progress. For more severe cases, various treatment options are available to straighten the fingers. These options may include needles, injectable medicine or surgery.
In 2010 the FDA approved Xiaflex injection as a treatment for Dupuytren’s contracture. Xiaflex is a collagenase enzyme that dissolves collagen found in Dupuytren’s cords. Treatment requires injection of the Xiaflex enzyme, followed by breaking of the contracting cords of Dupuytren’s (you will be numbed) 2 to 3 days later. Xiaflex (Collagenase) is a powerful enzyme and highly useful. It has low incidence of nerve injury and a remote low risk of tendon rupture. Advantages of Xiaflex treatment are that it is under local anesthesia, it is an in office procedure, and the recovery is much shorter than a surgical approach. It also removes the diseased tissue and lowers the recurrence rate.
What to expect with Xiaflex injection
The most common complications associated with Xiaflex injection are swelling, pain, bruising, skin break, and rarely <0.1% tendon rupture.