Dupuytren’s contracture occurs when the tissue below the skin of the palm begins to thicken. If you suffer from this hand condition, you will most likely notice bumps, thick cords, and indentations in your palm. Dupuytren’s contracture can also cause the fingers to bend towards the palm, as well as affect the knuckles and bottoms of the feet.
As Pittsburgh’s number one hand specialist, UPMC’s Alexander Spiess, MD specializes in providing specialized treatment for patients who are living with the discomfort of Dupuytren’s contracture. Using state-of-the-art technology, Dr. Spiess offers his patients thorough, compassionate care that is focused on helping them return to full functionality and find relief from debilitating pain.
If you’re ready to experience the best surgical care available from the top hand & wrist surgeon in the Pittsburgh area, you’ve found the right doctor. Reach out to Dr. Spiess’s office and schedule your first consultation today.
Treatment for Dupuytren’s contracture can range from simple observation to surgery, depending on how severe the case is. Since pain is rare, the main goal of treatment is to help the hand function like normal again. In mild cases, the disease may only need to be monitored, and it may not end up worsening. In more severe cases, treatment may include one of the following options to help straighten the fingers:
Dr. Spiess will recommend the best solution for your condition, taking into account the stage of your Dupuytren’s contracture and the joints affected. He will develop a personalized treatment plan that best suits your individual goals. He will help you understand what to realistically expect, including possible risks associated with the treatment.
After your treatment, you will need to wear a splint and undergo hand therapy to maintain the improved function of your fingers. Unfortunately, even with treatment, Dupuytren’s contracture may come back. Should this happen, Dr. Spiess will create a new treatment plan to increase your chances of proper hand and finger function in the long run.
For some patients struggling with Dupuytren’s contracture, there is a non-surgical option that can help. XIAFLEX® is an FDA-approved, nonsurgical treatment for adults with Dupuytren’s contracture when a “cord” can be felt. It starts breaking down the cord as soon as you receive the first injection. XIAFLEX® should be injected by a healthcare provider like Dr. Spiess, who is experienced in injection procedures of the hand and in treating people with Dupuytren’s contracture.
After injection, XIAFLEX® is thought to attach itself to the collagen that makes up the rope-like cord in the palm, unwinding the collagen and eventually breaking it down. However, the mechanism of action is not fully known. Studies show that prescription XIAFLEX®, along with a finger extension procedure, may help straighten or nearly straighten the affected finger and improve range of motion after up to 3 injections. 83% (206 out of 249) of patients were satisfied with XIAFLEX® compared with 30% (38 out of 125) of patients with placebo treatment.
In these 2 clinical studies, patients received up to 3 injections of XIAFLEX® or placebo into a cord that could be felt on Days 0, 30, and 60. About 24 hours after each injection, patients had a finger extension procedure and were fitted with a splint to wear at bedtime for up to 4 months. Patients also performed finger exercises every day. In these 2 studies, 60% of patients had a straight or nearly straight finger 30 days after the last injection on Days 30, 60, or 90 after up to 3 XIAFLEX® injections and finger extension procedures compared with 6% of patients who received placebo.
The most common side effects with XIAFLEX® in these studies were swelling of the injected hand and bruising or bleeding at the injection site, or lymph nodes
XIAFLEX® is given:
XIAFLEX® can cause serious side effects such as tendon rupture or ligament damage.
Those living with Dupuytren’s contracture often have it in both hands, which may have slightly different symptoms. One of the first signs that people notice are lumps and bumps in the palm. As the condition becomes more advanced, patients lose the ability to place their hand flat on a table due to the fingers being pulled into the palms. Other signs of the condition can be seen below:
Every case of Dupuytren’s contracture varies and progresses at a different rate. Some people only experience small bumps and cords on their hands, which may never worsen. Others have severe curling of their fingers and find everyday activities to be difficult, like washing the hands, shaking hands with others, and putting on gloves.
Dupuytren’s disease is a genetic condition, but the exact cause for developing Dupuytren’s contracture is unknown. However, if you identify with one of the following, you may be have a higher risk of developing it in the future:
While there are different theories as to what actually leads to Dupuytren’s contracture, there is no definitive evidence of these claims. There is likely an interaction between your genetic history and environmental exposure such as trauma or surgery to the hands.