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Hand FAQ

Question:

What's the prognosis for Duputren hand contractures? I've had the problem for a couple of years and just ignored it. Now I've lost the ability to straighten my fingers and I'm sorry I didn't so something sooner.

Answer:

Dupuytren disease of the hand has been around for hundreds of years. In fact, there is some research to suggest it was present back in the days of Vikings. Despite how long we have had to figure out the problem, modern medicine is still struggling to understand and effectively treat the condition. There is no cure and recurrence over time with treatment is likely. Scientists haven't found a specific gene responsible for Dupuytren disease. DNA technology has made it possible to identify quite a few genes involved in regulating the collagen fibers. Some genes are kept from doing their job of breaking down collagen, while others that normally build up collagen are increased. There are other risk factors including age, trauma, infection, alcohol use, diabetes, and smoking. What these risk factors have in common is narrowing of the small blood vessels in the hand. With narrowing of the microvessels comes a loss of blood supply, release of free radicals, and the formation of the wrong kind of collagen tissue. Free radicals are unstable atoms that have an unpaired electron. They cause tissue and DNA damage by robbing other atoms for electrons, thus forming a chain reaction of more free radicals. Understanding the cellular events that occur in Dupuytren disease has led to the development of more nonsurgical means of treatment. Surgeons can now perform a procedure called percutaneous fasciotomy (also known as a needle aponeurotomy). A needle is slipped in through the skin and used to cut the contracted cord. Afterwards, the patient sees a hand therapist who uses splinting and motion exercises to help the patient maintain finger motion. This approach is more successful if used early on. Recurrence rates are high in patients with more severe disease. Another newer treatment approach to this problem is the injection of collagenase into the diseased cords. Collagenase contains enzymes that go to work breaking down the collagen tissue. The procedure can be done in the physician's office and does not require anesthesia. The injections can be repeated up to three times over a 30-day period of time. Recurrence rates are unknown at this time but with long-term studies, this information will eventually become available and help guide treatment. Complications reported so far include swelling, bruising, pain, and skin problems. Less often, tendon rupture or complex regional pain syndrome develops. Surgery is still the treatment of choice for moderate-to-severe contractures and in the case of recurrence. As with any surgical procedure, there is always the risk of complications. Wound infection or delays in healing are the most common. But nerve damage and blood vessel injury are also possible. Recurrence after surgery is as high as 50 per cent. There is agreement that early treatment yields better results. Recurrence rates and spread of Dupuytren disease are more likely in moderate-to-severe disease. Even though you have had this problem for a couple of years, it is not too late to have treatment and with possibly better results than if you wait even longer. Bring this problem to your physician's attention and see what can be done about it now before any more time goes by and the condition worsens. Eric M. Black, MD, and Philip E. Blazar, MD. Dupuytren Disease: An Evolving Understanding of an Age-Old Disease. In Journal of the American Academy of Orthopaedic Surgeons. December 2011. Vol. 19. No. 12. Pp. 746-757.

*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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