Non-operative Treatment for Common Hand Deformity Comes to Yankton Medical ClinicMar 26, 2020 12:08PM ● By Med Editor
Dupuytren's contracture - also known as palmar fibromatosis - is an age-related hand deformity caused by gradual thickening of the fascia under the skin of the palm. Although the condition is not painful, it can cause a functional deficit. It is also more common in people of Northern European descent and much more common in men than in women.
“Dupuytren’s usually starts out as a lump in the palm that eventually may look like a cord or a tendon beneath the skin,” says Yankton Medical Clinic orthopedic surgeon Jessica Reissig, DO. “It can affect multiple joints and start to make the fingers flex down so people don’t have full use of their hands.”
Surgery has been the go-to treatment for more severe cases of Dupuytren’s contracture. A hand surgeon may perform a fasciotomy or even a subtotal palmar fasciectomy to loosen or remove the movement-limiting cords.
Unfortunately, Dr. Reissig says, surgical treatment rarely achieves more than an 80 percent correction. And it can limit the use of the hand for six weeks. Even with surgery, the chances of the condition returning are high.
That is why Dr. Reissig is now offering a newer injectable treatment for Dupuytren’s called Xiaflex (collagenase clostridium histolyticum). When injected directly into the bands of collagen in the palm, the medication weakens them. Manipulation is used to break the cords and a splint is applied to keep the fingers straight.
“A lot of people don’t end up coming to me because they think that the only option is surgery,” says Dr. Reissig. “Surgery is still a good option but a lot of people around here, like farmers and laborers, are very active and can’t afford to take time off for post-operative rehabilitation. This treatment is more geared toward general orthopedic surgeons like me, so it gives patients another option.”
After injection, the patient wears a splint 24/7 for a week, then just at night for four months. The injection can be repeated as soon as 30 days later, if needed, to achieve optimal results. Recurrence rates after Xiaflex are low in clinical trials with fewer than 5 percent of patients becoming symptomatic again within four years.
“This is a well-known, well-studied, and effective medication which makes this a low risk, high reward treatment,” says Dr. Reissig.
Reissig says Xiaflex is usually covered by Medicare and the manufacturer offers a supplemental program to help offset any out-of-pocket costs for patients. The FDA approved collagenase clostridium histolyticum for Dupuytren’s contracture in 2010.