Houston Methodist. Leading Medicine

Hand FAQ

Question:

I'm going to try a new treatment for my Dupuytren's disease. It's called collagenase injection. I do tend to develop allergies when exposed to new substances. Will that be a problem with this treatment technique?

Answer:

Dupuytren's disease refers to the tightening of a thin sheet of fascia or connective tissue called the aponeurosis. In the hand, the aponeurosis is shaped somewhat like a triangle. It is located just under the palm and covers the tendons of the palm, holding them in place. The fascia separates into thin bands of tissue at the fingers. These bands continue into the fingers where they wrap around the joints and bones. Dupuytren's disease causes contractures to form. The palmar fascia tightens, causing the fingers to bend and get stuck, unable to straighten. Collagenase is an enzyme that can be injected directly into the problem area. With Dupuytren's disease, the involved soft tissues include If you remember the little Pac-men in commercials for laundry detergent or the game Pac-man, you know that enzymes break down substances like dirt. In this case, they are being used to break down the collagen fibers that cause the tendon thickening. Studies done so far have used up to three injections, 30-days apart. Follow-up has shown that collagenase injections works best for patients who have the most problems at the metacarpophalangeal joints (MCPs). The MCP joints are what we more commonly refer to as the knuckles across the back of the hand. The injections have been used successfully for the proximal interphalangeal (PIP) joints but with less improvement of motion. The PIP joints are the joints in the middle of the fingers. It looks like collagenase injections work best for mild-to-moderate Dupuytren's disease. More severe cases improve but not by as much. Contractures (joint is stuck and can't move any farther) of 50-degrees or more don't seem to loosen up as much as contractures less than 50-degrees. Fingers that are contracted 40-degrees or less have the best results with more motion and fewer complications. Having an allergic response to the treatment is one of those potential complications. But studies so far have reported swelling of the fingers, bruising at the injection site, swollen glands, and skin itching that are self-limiting. That means the symptoms go away in a relatively short period of time. When tested, the majority (85 per cent) of patients studied showed that they had developed antibodies against the collagenase. These symptoms were not considered allergic responses. If you have not already discussed your tendency to have allergic reactions when exposed to new substances, be sure and bring this up at your next meeting. Your surgeons will want to be prepared for any possible reactions and minimize any adverse effects of the treatment. Ramesh C. Srinivasan, MD, et al. New Treatment Options for Dupuytren's Surgery: Collagenase and Percutaneous Aponeurotomy. In The Journal of Hand Surgery. August 2010. Vol. 35-A. No. 8. Pp. 1362-1363.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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