Office procedures for Dupuytren’s contracture
By Jared Alvey, OT/L, CHT
Dupuytren’s disease is a condition that affects the connection tissue fibers of the hand. It leads to the development of new tissue in the form of nodules and cords.
Over time, the cords shorten, pulling the fingers inward into a contracted or bent position. It can affect one digit or several digits, and it impacts hand function greatly.
Surgery has been the standard method of treatment, which involves removal of the diseased tissue from the palm. But there are less invasive office procedures available that may benefit some patients. They do not require hospitalization or being put to sleep.
Needle aponeurotomy is one such procedure. It involves the use of a needle that, through several repetitions, ruptures the cord, allowing for the fingers to then be manipulated or straightened. The procedure is done under local anesthesia in the office.
Injection of Xiaflex is another possibility. Xiaflex is a collagenase, which is an enzyme produced by the clostridium histolyticum bacteria. The enzyme destroys collagen – the main component of the cords that develop in the palm.
The procedure involves injection of the Xiaflex one day. Then the patient returns to the office the next day for manipulation to break the cords and straighten the fingers.
The patient is usually seen for one to two visits for therapy. The patient is seen the day of manipulation for the fabrication of a hand splint. The splint will keep the patient’s digits in a straightened position, maintaining gains from the procedure.
The patient will wear the splint at night for several weeks. A simple home program of range of motion exercises may be helpful as well.