Review of Dupuytren Disease ManagementOne of the many conditions that can affect your hand is Dupuytren disease. It was first written about in 1614 but it was only in 1831 that the disease was defined and described in detail to medical students. The disease is the thickening of the skin on the palm of the hand. This can happen on one hand alone, but often develops in both at the same time. For some people, Dupuytren disease goes beyond the palm of the hand, towards the fingers. The thickened skin begins to pull on the fingers and causes them to flex, or bend, to the point that they can't straighten out again. It's a slow progressing disease that also can affect the soles of the feet occasionally.
Dupuytren disease is more common in people with Northern European ancestry but how many people are affected isn't known. The reports vary from 2 percent to 42 percent. It is more common as people get older, usually in the fifties and men are diagnosed with it six times more often than women are. Other people who seem to develop Dupuytren disease more often are those with diabetes, who drink alcohol, who smoke, who have a traumatic injury to the affected hand(s), and those who do manual labor with vibrations to the hand, such as using a jack hammer.
While many patients with Dupuytren disease don't need treatment, those whose disease affects their fingers can end up losing the ability to use their hand. In that case, surgery is the usual treatment. Unfortunately, because the disease is progressive, the surgery does have its limitations. The disease will continue to progress and continue to cause contractions, keeping the fingers flexed. This is particularly important if the patient is young. Also, research into surgery for Dupuytren disease has found that complications occur after surgery in about 17 percent to as much as 50 percent of the time. Some of these complications include stiffness in the fingers, infections, and injuries to the tendons, the thick fibrous tissue that controls your finger movements.
To try to overcome the problems with surgery, researchers have been looking into other methods of treatment. One such treatment, percutaneous needle fasciotomy was the standard treatment for 150 years, beginning in the 18th century. It fell out of popularity because of its high rate of complications, but the technique was brought forward again in the 1970s, with a finer technique and fewer complications. At this point, the treatment has become fairly popular because of the patient's quick recovery and the lower risk of serious complications. The problem is, though, that the fasciotomy doesn't cure the disease, only the finger problem over the short term. There is also a school of thought that believes that the trauma caused by surgery may "awaken" the disease and cause it to spread faster along the hand and fingers.
Another approach to treatment is called the collagenase injection. This approach was tried because researchers felt that the therapy may work on the disease process itself. Collagen is a protein that helps bind together connective tissue. Collagenase is an enzyme that breaks down collagen. Researchers felt that by injecting a substance that would break down the collagen would release the fingers. Results of some small studies are finding that collagenase injections may be helpful. Complications to the injections are related to the injection itself, such as pain where the injection was given and swelling.
In conclusion, the authors wrote that there have been advances in the treatment of Dupuytren's disease but that the disease itself is still not understood.
Ryan J. Caulfield and Scott G. Edwards. Dupuytren disease: An update on recent literature. In Current Orthopaedic Practice. September/October 2008. Vol. 19. No. 5. Pp. 499-503.
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