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Tag: Dupuytren’s Contracture Treatment

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Conditions Fingers General Hands

What are the Causes of Dupuytren’s Contracture?

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Do you think you’re one of the approximately seven percent of Americans dealing with Dupuytren’s contracture? Do you even know what this surprisingly common condition is?

Read on to learn more about what Dupuytren’s contracture is and for some useful information on how to treat it and improve your quality of life.

What is Dupuytren’s Contracture?

Let’s start by clearing up what Dupuytren’s contracture actually is.

Dupuytren’s contracture, which is also known as Dupuytren’s disease, is a condition that involves the tightening and thickening of the fascia (connective tissue) of the fingers and palm of the hand.

Normally, fascia is very elastic. But, for people suffering from this condition, the fascia is tight, to the point where it can cause the fingers to curl inward. It can even cause severe deformities that limit overall hand function.

Common Causes

Dupuytren’s disease doesn’t have a single known cause. But researchers have found that it often runs in families, and people of certain heritages are more likely to develop it.

Those who are more susceptible to the condition include people of Northern European or Scandinavian descent.

Certain illnesses and lifestyle factors can influence a person’s likelihood of Dupuytren’s contracture, too. Common ones include:

  • Excessive alcohol consumption
  • Diabetes
  • Epilepsy and seizure disorders
  • Smoking

Men who are in their 40s or older are also more likely to develop Dupuytren’s disease than women. For both genders, the chances of being diagnosed increase with age.

Symptoms

How do you know if you have Dupuytren’s contracture?

Most people start by noticing small lumps, or nodules, under the skin on the palm of their hand. The nodules will usually be sore and tender at first, but the discomfort will subside with time.

After they first develop, these nodules will cause tough bands of connective tissue to appear under the skin. These bands will cause the fingers to curl inward and will hinder one’s ability to straighten their fingers.

The ring and pinkie fingers often are affected first.

Dupuytren’s contracture usually affects both hands, but one hand may present more serious symptoms than the other.

As the condition progresses, it can become difficult to perform everyday tasks like placing your hands in your pockets or picking up large objects. Even actions like shaking hands, wearing gloves, or placing your hand flat on a surface become challenging.

When Should You See a Hand Doctor?

The sooner you speak to a doctor about your condition, the sooner you can start treatment and avoid the debilitating symptoms that occur as the disease progresses.

If you notice lumps on your palm — even if they’re not painful — you should make an appointment with the doctor.

If you’re already experiencing more advanced symptoms, like difficulty straightening the fingers or grasping objects, it’s even more important for you to make an appointment.

Diagnosis

When you visit the doctor, he will examine your wrists, hands, and fingers. He will pay special attention to the palms to check for nodules and count how many are currently present.

The doctor will also most likely have you perform a series of tasks to see how far the disease has progressed. Common tests include:

  • Placing your hand flat on a table
  • Grasping and pinching items with the hands and fingers
  • Checking the amount of feeling you have in the fingers and thumbs
  • Measuring range of motion

The doctor will repeat these tests and exams regularly to see if your condition is improving or getting worse.

Nonsurgical Treatment Options

Dupuytren’s contracture doesn’t have a cure. However, there are also a number of nonsurgical treatment options that the doctor will suggest first to help you manage your condition and improve your quality of life.

Some common nonsurgical treatments that the doctor will likely start with include:

Stretching

When Dupuytren’s disease is in its earliest stages, many doctors start by recommending regular stretching exercises to improve range of motion and slow the disease’s progression.

Common exercises include flexion exercise, grip strengthening exercises, and isolation exercises.

Steroid Injections

An injection of corticosteroids, a type of anti-inflammatory medication, can help reduce the size of nodules when the disease is in its early stages. They also can help slow the progression of Dupuytren’s contracture.

But, if the thickened tissue has already formed, or the fingers are already starting to curl, steroid injections don’t seem to be particularly effective.

Enzyme Injections

Your doctor may also try injecting an enzyme mixture into the thickened tissue to try and loosen it up. After the injection, doctors sometimes try to stretch and straighten out the fingers.

Enzyme injections can be effective, but most people require two to three of them before they see improvement. They also come with some minor side effects like swelling, bruising, and bleeding.

Less Effective Treatment Options

Some doctors recommend treatments like low energy radiation, ultrasound, or Vitamin E cream to treat Dupuytren contracture. These treatments are not well researched and generally are not as effective as the options mentioned above.

It’s also important to avoid splinting your fingers. It might seem like a good idea to force the fingers to straighten. But, the force from the splint can actually backfire and cause the finger to curl inward faster.

Surgical Treatment Options

After trying nonsurgical treatment options, your doctor may suggest surgical intervention if your condition doesn’t seem to be improving.

There are three different types of surgery that doctors perform to treat Dupuytren contracture:

Needle Fasciotomy

Also known as a percutaneous needle fasciotomy or a needle aponeurotomy, this is an outpatient procedure that is performed with just a local anesthetic.

During this procedure, the doctor will insert a fine needle or very sharp blade into the connective tissue of the palm or fingers. They’ll then use the needle or blade to divide the bands and release the tension that causes the hands to curl.

Some of the benefits of this procedure include:

  • Fewer deformities of the hand
  • Faster recovery
  • Low risk of complication

A needle fasciotomy is also a good option for older patients for whom extensive surgery is not safe.

Open Fasciotomy

Another option is an open fasciotomy. This procedure is usually used for more severe cases. There is more long-term relief from an open fasciotomy compared to a needle fasciotomy, but it’s also more extensive.

An open fasciotomy is an outpatient procedure, like a needle fasciotomy, and it’s performed under local anesthetic.

During this procedure, the doctor will create an incision to access and divide the thickened connective tissue to improve your ability to straighten your fingers. They’ll then seal the wound with stitches and apply a dressing.

Since the wound is larger from this procedure, recovery time is a bit longer. You’ll also need to plan for a second appointment to have the stitches removed, and you’ll likely have a scar left over.

Fasciectomy

The most invasive surgical option for Dupuytren contracture involves removing the thickened bands of tissue altogether.

There are three different variations of a fasciectomy:

  • Regional: The doctor removes the affected connective tissue through one large incision
  • Segmental: The doctor removes small segments of tissue through one or more small cuts
  • Dermofasciectomy: The doctor removes affected connective tissue and overlying skin that may be damaged, then seals the wound with a skin graft

Unlike the other two options, a fasciectomy will most often be carried out under general anesthetic. You’ll be unconscious during the procedure and won’t feel any pain.

Because of the use of general anesthesia, there are more risks that come with a fasciectomy. But, complications are still unlikely, and the results of a fasciectomy usually last longer than the results of a needle or open fasciotomy.

Potential Complications

Complications are quite rare. But, the most frequently experienced ones include:

  • Infection
  • Potential nerve or blood vessel injury
  • Permanent stiffness in the fingers

In the months following your surgery, it’s common to experience some swelling and discomfort.

Recovering from Hand Surgery

Most people see significant improvement in the range of motion in their fingers following surgical intervention, especially with the help of physical and occupational therapy.

After surgery, you’ll probably be able to return to your daily activities, including driving, after about three weeks. Recovery can be a bit longer for people who have had skin grafts.

You should refrain from heavy manual labor and intense physical activity for about six weeks to ensure proper healing.

Chances of Recurrence

Surgery is highly beneficial, especially for people who are experiencing limitations in their daily activities as a result of Dupuytren’s contracture.

However, it’s important to note that there is a chance that the condition will return. People with a strong family history or those who had particularly severe contractures are more likely to experience a recurrence after surgery.

The chances of recurrence are also higher in needle fasciotomies than fasciectomies. Dermofasciectomy has the lowest risk of recurrent (less than one in ten).

Get Treatment for Dupuytren’s Contracture Today

Do you think you’re suffering from Dupuytren’s contracture? Are you looking for treatment and relief from your symptoms?

If so, contact us today at Arora Hand Surgery to schedule a consultation. We proudly serve people throughout the state of Michigan, and we’re eager to help you improve your symptoms and start feeling your best.

Categories
Conditions General Treatments

XIAFLEX for Non-Surgical Dupuytren’s Contracture Treatment

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Dupuytren’s contracture is a disease that primarily affects men of North European descent. The primary symptom of the disease is a deformity of the hands that gets worse over the years. The condition damages the tissue that is right under the skin in the palm. The palm develops a knot of tissue that eventually becomes a thick cord. The thick cord eventually exerts pressure on a couple of fingers in the hand, leaving them in a permanently bent position.

Since the affected individual cannot straighten their hands, easy activities start to become a challenge to perform. For example, trying to put your hands in your pockets becomes impossible because you cannot straighten out all of your fingers. The same is true with wearing gloves or trying to shake another person’s hand.

While the disease can affect any of your fingers, it is more commonly seen in the ring finger and the pinky. While there is no cure for the disease, there are some treatments that are designed to slow down how quickly the disease progresses or relax some of the contractions in the hand. At Arora Hand Surgery, we may use XIAFLEX, an injectable enzyme, as part of a non-surgical Dupuytren’s contracture treatment regimen.

Causes and Symptoms of Dupuytren’s Contracture

Scientists are still mystified as to the exact cause of Dupuytren’s contracture. They have seen a link between individuals who have certain forms of diabetes, epilepsy, alcoholism and seizure disorders.

Dupuytren’s contracture is a hereditary disease. It is most often seen in men who are over the age of 50. The disease may affect both hands at the same time or just affect one hand. It is very rare that an individual suffering from this disease experiences pain. Most patients only report pain if they attempt to forcibly hyperextend their fingers.

While this disease primarily affects a person’s hands, researchers have seen it affect the soles of the feet as well. Doctors are able to diagnose the disease during a visual examination of the affected hand. Usually, other tests such as X-rays are not needed. At times, injuries to the hands, such as burns or other injuries that cause scar formation, might mimic Dupuytren’s contracture.

XIAFLEX: An Exciting Dupuytren’s Contracture Treatment Option

XIAFLEX is a relatively new treatment option for Dupuytren’s contracture. It works by breaking up the collagen-based scar tissue that forms in the hands, causing them to bend in an awkward position. As collagen formations break up, they become loose and the contracted tissue is able to return to normal mobility.

XIAFLEX is delivered via injection. Most patients are able to grasp objects, flex their fingers and have improved dexterity in their hands after a series of these injections.

This enzyme injection has been a lifesaver for many patients. This is because there is nothing that can be done to prevent Dupuytren’s contracture from developing. Since the disease develops slowly, treatment, especially treatment that begins early, generally works well.

With the proper Dupuytren’s contracture treatment, most patients are able to improve their quality of life drastically. During a consultation at Arora Hand Surgery in Macomb, Warren, Howell, or West Bloomfield, you can learn more about your treatment options for your condition. Contact us today to schedule an appointment!

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Dr. Aroras office from my first call to schedule my appointment was friendly. Walking in the first day, I felt like I was in a nice atmosphere. Dr. Arora was EXCELLENT in taking great care of my hand injury. He was gentle and very understanding to the concerns I had about my hand. His expertise was admirable and I would recommend anyone with an injury to their hand to his office to be under his care. Because of him, I have healed faster than expected and will make an 100% recovery! Thank you Dr.

Jackie S.

I first thought I was going to have to have painful injections or surgery, but Dr. Arora suggested physical therapy may do the trick. I was doubtful, but I agreed to do it. Now, my pain is gone, and with the help of an ergonomic keyboard at work to keep my hands in the correct position, I am virtually pain free. The therapy strengthened my wrists and shoulders, and built more flexibility into my wrists.

Jerry T.

My experience with this doctor was positive from the outset. Dr. Arora was kind and spent a great deal of time with me. Staff was friendly. The office was nice and bright.

Ariel G.

Very friendly and helpful Great staff!!! Doctor Arora was very professional and did great work. I was very happy with everything!

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