Dupuytren’s contracture is a hand deformity that results from an abnormal thickening of the fascia or fibrous tissue of the palm. This thickening gradually turns into a rope-like cord that will extend to the fingers, generally the small and ring finger, and pull the fingers towards the center of the palm. As the disease progresses, a person may not be able to totally straighten his fingers, causing a significant reduction in daily functioning.
No exact cause has been identified as the root of the problem, but there are specific attributes that may predispose a person to developing the contracture more than the average person. Genetics, race, age, gender, and preexisting conditions may all play a role in increasing the likelihood of getting the condition. Once the disorder has been confirmed through physical exams, history taking, and other diagnostic procedures, the next step is to determine whether treatment is needed and what methods will be used. In mild cases, only observation is done, while severe cases do need to be treated. Here are the various approaches to treat Dupuytren’s Contracture:
Radiation therapy may prove useful in treating the condition when it is still in the early stages. It was in 1955 that the effects of treating with radiation were first cited in the UK’s British Journal of Radiology. Today, radiation therapy is included as one of the major treatments administered for Dupuytren’s contracture patients in Germany as well as in some parts of the United States.
The patient generally receives radiation for the nodules and cords for five days in a row. After that, he has to let 12 weeks pass before he can receive another radiation treatment. X-ray is usually used, but just recently, E-beam radiation also entered the scene. The radiation treatment’s main goal is to halt the progression of the condition and has been documented to be quite successful at a rate of 85 percent.
Collagenase is an enzyme that breaks the peptide bonds found in collagen. As such, small amounts of it are useful in weakening the cords found in the palms of people with Dupuytren’s Contracture. Injectable collagenase, extracted from Clostridium histolyticum, was approved as a treatment for the condition by the United States Food and Drug Administration in the early part of 2010. It is available in the US market as Xiaflex, which is sold by Auxilium Pharmaceuticals. About a year later, Europe also accepted the injections as a viable form of treating the disorder when the European Commission’s Committee for Medicinal Products for Human Use gave its approval. The preparation is available in the European market as Xiapex, which is sold by Pfizer. Several studies have been conducted, but further research is required to gather more data on the recurrence rates, complications, and long-term results of collagenase treatments.
Physical and Occupational Therapy
Physical therapy, especially when augmented by the use of ultrasonographic waves and heat application, has a lot of benefits for the patient with Dupuytren’s contracture in its early phases. Not only may splints and braces be applied to help stretch the fingers, but stretching exercises may also be prescribed to achieve the same purpose. Furthermore, the patient may be required to undergo, several times per day, some range of motion (ROM) exercises. Occupational therapy is also vastly helpful. This treatment modality aids a patient in developing techniques to adjust to the deformity as well as help him use some assistive devices that will make daily living that much easier, despite the debilitating effects of the condition.
Severe cases may need surgical interventions. There are many types of operations that are used to treat Dupuytren’s Contracture. In general, there are two types: invasive and minimally invasive surgery. The former involves the total removal of the pathological tissue with the patient under local, regional, or general anesthesia. Limited fasciectomy, wide awake fasciectomy, and dermofasciectomy belong to this category. Minimally invasive surgery still makes use of some type of anesthesia, but removes only enough of the pathological tissues so that the fingers are no longer contracted towards the palm. Extensive percutaneous aponeurotomy and lipografting, percutaneous needle fasciotomy, and segmental fasciectomy are included in this category.
Dupuytren’s contracture, just like any other disease, is best treated when it is still in its early stages. Knowledge about the condition and its symptoms is proven to be a valuable preemptive measure.