This is “the most common cripple hand condition people have never heard of,” says Executive Director Charles Eaton. Dupuytren Research Groupwhich estimates that at least 10 million Americans have Dupuytren.
Once the problem begins, many people mistakenly think they have arthritis or tendonitis, or don’t realize they have a problem until their fingers begin to bend.
“It tends to progress very slowly,” says Eaton, adding that only about a fifth of people with early signs of the disease develop badly crooked fingers.In about 10%, the lump disappears. But the rest are either unchanged or crooked fingers that aren’t severe enough to require intervention, he says.
Eaton Group register a person For studies that collect and analyze blood samples to discover biomarkers (one or more molecules unique to Dupuytren) Scientists design drugs to treat it, with or without Dupuytren may help you to Eaton says this is a first for Dupuytren’s work.
Although the disease is incurable, there are non-invasive and surgical treatments, the latter usually reserved for patients with advanced disease. and can impair quality of life.
“I can drive, but I have trouble holding things,” says Schultz. He has had 5 surgeries on him (his 4 on his left hand and 1 on his right) and he may need to have 2 more surgeries as his hands are deteriorating again. not. “My fingers don’t open wide enough, so I have to carefully lift bottles and thermoses. I used to play a lot of golf, but now I have a hard time gripping the golf club.”
Gary Pesce, a hand surgeon and medical director of Central Jersey Hand Surgery in New Jersey, agrees that the condition can be life-changing. “It’s hard to do simple things you love,” he says. “It’s hard to hold a child or put your hands in your pockets. prize.”
Risk factors include family history of the disease, increasing age (after age 50, the likelihood of developing Dupuytren steadily increases), Scandinavian or Nordic ancestry, tobacco and alcohol use, seizure medication use, and diabetes. It occurs more often in men than women.
Doctors usually recommend surgery if a patient cannot pass the “tabletop” test, that is, if they cannot lay their hands flat on a table, palms down. But don’t wait for this to happen before seeing a doctor, experts warn: “Early treatment can greatly improve your chances of success,” Pess said. increase.
Keith Denkler, a plastic surgeon in Larkspur, Calif., who estimates he’s treated about 10,000 Dupuytren fingers to date, agrees. “It can’t be cured, but it can improve hand function and stave off the worst effects,” he says. “My philosophy is to do the easy thing instead of waiting for it to go bad.”
One do-it-yourself approach to minor ailments is padding, Alternatively, build handles out of pipe insulation or buffer tape, and use deep padded gloves for tasks that require holding heavy objects, such as weightlifting or trimming hedges.
If that doesn’t help, other initial treatments include:
Needling. In this approach, needles are inserted into the skin to break the ligaments of tissue that cause the contracture. If the bend returns, you can repeat. There are no incisions and little physical therapy is required after surgery. However, practitioners should be careful not to damage nerves or tendons.
injection. Doctors inject enzymes into stiff cords to soften them and weaken them so that they can break and straighten your fingers. One product, Collagenase Clostridium histolyticum (marketed as Xiaflex), has been approved by the Food and Drug Administration for this use. Some doctors recommend cortisone injections for early disease.
Extracorporeal shock wave therapy. A few the study suggestion It is effective in reducing pain and slowing the progression of Dupuytren’s disease. “It works by angiogenesis or the formation of new blood vessels,” said John L. Ferrell III, director of sports medicine at DC-based Regenerative Orthopedics and Sports Medicine. “If we can treat Dupuytren’s disease early, we can increase blood flow to this area that has a poor blood supply. This seems to reduce pain and help slow the progression of the disease.”
Problem: Although this therapy is FDA-approved for the treatment of other musculoskeletal disorders, it is still an “off-label” treatment for Dupuytren’s disease and is not widely used to treat this disease.
surgery It is the only treatment for advanced disease. This includes an incision to remove the affected tissue and straighten the finger. Denkler says that up to 25% of patients undergoing invasive surgery will relapse within five years.
“Surgery cuts away tissue, but it can reshape,” he says. “Dupuytren’s disease is a scarring condition, and surgery is a scarring procedure, so it can fail.”
Open surgery is generally more effective for more severe flexions and lasts longer, but it also has a higher rate of permanent complications, Eaton says, and patients can suffer from nerve damage that causes pain, swelling and numbness. , circulation problems to the fingers, and hand stiffness.
And “if the problem recurs, the risk of complications from reoperation is even greater,” he adds. .”
