New Treatment Unlocks Curled Fingers
Loyola University Health System is among the first centers to offer a new, nonsurgical treatment for Dupuytren’s contracture, a debilitating condition that curls fingers toward the palm.
Dupuytren’s contracture affects one or more fingers, usually the little finger and ring finger. Growth of a cord of tissue under the skin causes the finger to bend inward so that the finger can not be straightened.
The traditional treatment is outpatient surgery to remove the tissue, said Loyola hand surgeon Dr. Randy Bindra. The patient has stitches for 10 to 14 days and needs to do physical therapy. It takes one to three months before the fingers become fully flexible.
The new drug is Xiaflex® (collagenase clostridium histolyticum). In an outpatient clinic, a doctor injects the drug into a Dupuytren’s cord that is causing the finger to bend. The drug contains enzymes that break down collagen, one of the main components of the cord.
The patient returns to the clinic the next day, and the physician gently extends the finger to break the cord. “The patient feels a pop and the finger opens up,” Bindra said. No physical therapy is needed.
The treatment worked well for James Santo, 83, of Chicago. Santo had Dupuytren’s contracture on the little finger of his right hand. His finger curled so much the tip touched the palm of his hand.
Bindra administered one injection. Santo said it felt like an ordinary shot, and he experienced no pain afterward.
Santo can now extend his finger until it is nearly straight. “It’s normal now,” he said.
A study of 306 Dupuytren’s contracture patients found that 64 percent had a straight or nearly straight hand after one to three injections of the drug, compared with 7 percent who received a placebo. The Food and Drug Administration, which approved the drug, called it “an important advance in the management of this disabling condition.”
Bindra said the injections must be carefully administered, because the drug can dissolve collagen in healthy skin and tendons. If injected in the wrong spot, the drug can snap a tendon and leave the patient unable to close the finger. As a hand surgeon who has done more than 100 surgeries for Dupuytren’s contracture, Bindra knows exactly where to inject the drug.
Dupuytren’s (du-pwe-TRANZ) contracture is a hand deformity that usually develops slowly, over decades. Dupuytren’s contracture affects the connective tissue under the skin of your palm. Knots of tissue form under the skin - eventually forming a thick cord that can pull one or more of your fingers into a bent position.
Once this occurs, the fingers affected by Dupuytren’s contracture can’t be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands.
Dupuytren’s contracture most commonly affects the ring finger and pinky, and occurs most often in older men of Northern European descent. A number of treatments are available to slow the progression of Dupuytren’s contracture and relieve symptoms.
The Food and Drug Administration said the drug should be administered only by a health care professional experienced with the anatomy of the hand, because tendon ruptures can occur.
The most common adverse reactions to the drug are fluid build-up, swelling, bleeding and pain in the injected area, the FDA said.
Dupuytren’s contracture typically progresses slowly, over several years. Occasionally it can develop over weeks or months. In some people it progresses steadily, and in others it may start and stop.
Early symptoms
Dupuytren’s contracture usually begins as a thickening of the skin on the palm of your hand. As Dupuytren’s contracture progresses, the skin on the palm of your hand may appear puckered or dimpled. A firm lump of tissue may form on your palm. This lump may be sensitive to the touch but usually isn’t painful.
Later symptoms
In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and may extend up to your fingers. As these cords tighten, your fingers may be pulled toward your palm, sometimes severely.
The ring finger and pinky are most commonly affected, though the middle finger also may be involved. Only rarely are the thumb and index finger affected. Dupuytren’s contracture can occur in both hands, though one hand is usually affected more severely than the other.
Bindra said the drug does not necessarily cure the condition. In some patients, the abnormal tissue grows back and curls the finger, requiring further treatment.
Dupuytren’s contracture often runs in families. It is more common in men, especially in the case of Northern European descent. Other risk factors include increasing age and certain medical conditions, such as diabetes and seizures.
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Source: Loyola University Health System