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Is There a Non-Surgical Treatment for Dupuytren's Contracture?

January 13, 2021

Dupuytren’s (which is pronounced du-pwe-trenz) Contracture is among those diseases that are actually quite a common disease that almost no one has ever heard of. Dupuytren's Contracture is a deformity of the hand that affects some of the tissue that sits under the palm. With Dupuytren's, the tissue develops knots, which eventually form a thick cord that can permanently pull fingers into a position in which they look bent.

Worse, once the disease has taken control of your hands, it's impossible for the victim of Dupuytren's Contracture (DC) to straighten out the fingers. Obviously, that person will find a lot of formerly easy tasks to be almost impossible, such as reaching a hand into their pocket, slipping on gloves or shaking hands with someone. .

Worse, once it has taken control of your hands, it's impossible for the victim of Dupuytren's Contracture to straighten out the fingers. Obviously, that person will find a lot of formerly easy tasks to be almost impossible, such as reaching a hand into their pocket, slipping on gloves, or shaking hands.

How Does Dupuytren's Contracture Develop?

For the most part, Dupuytren's Contracture progresses slowly, over many years. It starts out as a thickening of the skin on the palm, and as it progresses, it can make the palm look puckered or dimpled. Although the lump may be sensitive, it is virtually never painful.

As Dupuytren's Contracture reaches the later stages, the knots of tissue can extend up into your fingers. And as they tighten, the fingers affected may be strongly pulled in the direction of the palm.

For the most part, Dupuytren's Contracture primarily affects the two fingers farthest from the thumb and happens most often to white men of Northern European descent, usually between the ages of 40 and 60. There is no cure for Dupuytren's Contracture, but there are treatments available capable of relieving symptoms and slowing progression of Dupuytren's.

The "contracture" can happen in either hand. While the middle finger is also commonly affected by Dupuytren's Contracture, it is extremely rare for either the thumb or the index finger to be involved. 

Who Gets Dupuytren's Contracture and Why?

As of now, medical experts and physicians have no idea what causes Dupuytren's contracture. There are genetic tests that can help predict who is more likely to suffer from the condition, but there is no way to tell when it will happen or how severe the symptoms will be Despite those consistencies, however, how the condition develops seems to vary from one patient to another.

It's possible for one patient to develop a small nodule that never develops beyond hat, while others see rapid and constant progressions that become debilitating relatively quickly.

Although some have expressed a belief that the condition is caused by hand injuries or exposure of the hands to constant vibrations while earning a living, there is no evidence that is the case.

How Do I Know When I May Have Dupuytren’s Contracture?

The time to speak to your doctor about concerns about your hands is before a problem is apparent. The first signs that you might be suffering from Dupuytren’s Contracture come with the appearance of small bumps or pits in the palm. For the most part, they will be found near the pinky and ring fingers.

These abnormalities are caused by growths within the fascial layers of the hand, where fibrous tissue will begin to build up and create something that looks like "knots," which will eventually shorten. These can eventually cause the fingers to bend into the palm and stay that way.

From a functional standpoint, the fingers becoming bent can be physically debilitating.

For example, if you are unable to put your hand in a glove or a pocket, or if you are unable to wrap your hand around anything the size of either a bottle or can of soda, or if you can't wash your face without poking yourself in the nose or the eye, you may have a problem with Dupuytren’s Contracture.

What Can I Do About Dupuytren's Contracture?

For the most part, Dupuytren's Contracture primarily affects the two fingers farthest from the thumb, and happens most often to older men of Northern European descent. There is no cure for Dupuytren's Contracture, but there are treatments available capable of relieving symptoms and slowing progression.

If the condition progresses very slowly, and there is no pain, and little or no impact on your every day life, it's entirely possible you won't need treatment at all. However, if you feel that you need treatment, there are a number of ways to do that.

The most common treatments these days are surgical in nature, but a number of studies have shown to be of minimal effective. For instance,one study of victims of the condition, from Northwestern University in Chicago, found that 43 percent of respondents who received surgical treatment "had recurrent deformities severe enough" to warrant additional surgery.

Think about it; if your doctor told you the surgery he wants you to have is effective just over half the time, you're not likely to be impressed enough to go through it, at least willingly. 

Which Surgical Treatments Are Available?

One surgical treatment is called needling. With this treatment, a needle is inserted through the skin and is used to puncture the tissue knots that cause the fingers to lose their shape, as a way to break them. As is the case with surgery, the people with Dupuytren's Contracture who opt for this treatment method often see a  recurrence.

The primary advantages to needling over more conventional surgery are that it can be performed on several fingers simultaneously, and it rarely needs physical therapy afterward. However, one disadvantage is that it can't be used in some places in the finger, where it could cause nerve or tendon damage.

What About Non-Surgical Treatments?

One non-surgical treatment involves enzyme injections. With this treatment, the doctor inject a type of enzyme into the palm. This enzyme softens and weakens the palm, which will allow the doctor to manipulate your hand in a way that helps him break the "knots" of tissue and straighten out your fingers.

In line with those non-surgical treatments, the FDA also has approved collagenase Clostridium histolyticum (marketed as Xiaflex) for the purpose of treating Dupuytren's Contracture. Xiaflex works much like enzyme injections, except that it is now more widely available. 

The pros and cons of getting a Xiaflex injection are almost identical to those for enzyme injections. This prescription medication has been hailed as the biggest medical advancement for the condition since it was first described by Guillaume Dupuytren way back in 1834.

There is another thing to question before saying yes to a Xiaflex injection, and that is the list of side effects, which is considerable.

In addition to the possible nerve, tendon, or ligament damage, should the injection miss its mark, there is also the possibility of hypersensitivity allergic reactions, which can include hives, numbness, tingling, trouble breathing, or even anaphylaxis.

There is Also Now an OTC Cream Available

Thankfully, there is now also an over-the-counter cream available for those who suffer from Dupuytren's Contracture, so there is no need to deal with the potential side effects from a prescription medication. 

Dupuytren’s Cream is the only non-invasive treatment on the market to treat Dupuytren's Contracture patients that promises relief from the symptoms that accompany the condition, without injections and without having to endure breaking apart tissue and risking the health of your hand in the attempt to fix the problem. 

The manufacturers have promised that Dupuytren’s Cream has the anti-inflammatory properties of their Dupuytren's Contracture that causes their fingers to curl and their hands to look deformed. 

Sometimes, Nothing But Surgery Will Help

In many cases, even with all of these non-surgical treatments, surgery will still be necessary to reverse some of the effects of Dupuytren's Contracture. (If you're looking for a cure, in which you get full use of your hand back, that won't happen) If that happens, you will need surgery. 

There are two types of surgery available. As noted, the least invasive surgical treatment available is "needling," in which a surgeon uses needles to break up the fibrous tissue that is causing the fingers to bend involuntarily.

The other surgical procedure involves lifting up the skin of the palm and surgically removing all of the abnormal tissue "knots" before replacing the palm skin. Unlike "needling," this type of surgery will require a splint, as well as a significant level of hand therapy.

When it comes to Dupuytren's Contracture, the overall goal for any treating physician is to help the patient maintain as much hand function. The best way to accomplish that is to catch the problem early, which is why it is best to pay attention to your body and see a hand specialist as soon as possible.

That hand specialist can work with you starting early on and perhaps head off the progression of the disease before it gets to the point of debilitation.


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