I am a band leader for a swing band that plays at weddings and entertainment events. My drummer has developed something called Dupuytrens disease of his fingers. He's going to try and bypass surgery by having some kind of injections. We have a lot of gigs scheduled this month. How long will recovery take?
Dupuytren's contracture is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. It occurs most often in middle-aged, white men. This condition is seven times more common in men than women.
The condition commonly first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytren's contracture usually affects only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized.
The areas affected most often are the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The MCP joints are what we usually refer to as the knuckles. The PIP joints are the middle joints between the knuckles and the joints at the tips of the fingers.
Surgery to release the cords has long been the standard treatment for this condition. But more recent research has resulted in a less invasive method of treatment called an enzymatic fasciotomy. It sounds like this is the type of injection therapy your drummer is thinking about having done.
By injecting an enzyme directly into the cords formed by the disease, the tissue dissolves and starts to weaken. Most often the patient or the surgeon is able to break apart the cord the next day if spontaneous disruption does not occur. Just actively moving the fingers and using the hand are often enough to accomplish this.
There are a few adverse reactions that can develop. Local skin reaction (rash and swelling) can occur at the site of the injection. Blood clots, tendon ruptures, infections, and nerve damage are some examples of problems that can develop afterwards as a result of the treatment.
Most adverse events after treatment are mild and go away in 10 to 14 days. Patients probably won't need hand therapy after the injection treatment but may need to wear a splint at night for a few months.
JÃ¶rg Witthaut, MD, et al. Efficacy and Safety of Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture: Short-Term Results from 2 Open-Label Studies. In The Journal of Hand Surgery. January 2013. Vol. 38A. No. 1. Pp. 2-11.
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