Dupuytren’s disease is a disease of fibres that hold the palmar skin to the underlying tissues. This allows humans to grip objects without the skin of the palm slipping. This is a common disease in Northern Europeans and is said to originate from the Vikings. This is often inherited and can also affect the feet. It commonly affects men in the middle ages and its onset may be accelerated by trauma.
A band or nodule usually arises in the palm of the hand. This nodule then gradually progresses to becoming a band that pulls the ring, little and the middle finger down into the palm of the hand. This can affect other areas in the hand. This can occur elsewhere in the body.
Treatment may be required depending on the stage of the disease.
This is a treatment Mr Khandwala has been using for about 2 years. An enzyme that dissolves the collagen fibres of the contracture is injected directly into the fibres. A few days later the finger is manipulated to break the co rd and achieve a straighter finger.
The enzyme dissolve collagen and needs to be injected at specific points. The injected area will normally swell, bruise and become painful. Some patients experience tracking and bruising going into their armpits.
This is a painful injection but spares the patient surgery and can be a good first line treatment prior to considering surgery. Recovery is quicker but there is not enough evidence on the incidence of recurrence following this injection.
Complications include swelling, Bruising, Skin break, with a rare chance of tendon or pulley rupture if this is inadvertently injected into a tendon.
Nerve damage (rare with collagenase) Nerves to the finger are intimately related to the duputrens tissue and may be compressed by the process or suffer damage during manipulation.
This can result in numbness in the finger and can occasionally lead to pain. Recovery from nerve damage can take up to two years and may be incomplete.
Bleeding, infection and break in skin can occur and is more common in smokers. Some Scarring will always occur in all the operated sites and this can be variable.
Stiffness can occasionally be a problem and exercises are prescribed in the early days to ensure that stiffness does not occur. It is very important to carry out these exercises.
Cold intolerance The hand can be insensitive to cold weather for a few years following surgery. This is especially true in smokers.
Nerve recovery It can take up to three years depending on the age group of the patient. In most patients without permanent nerve damage the sensation is normal and symptomatic relief is almost immediate.
Loss of power There is a weakness of the hand following this surgery. This generally improves over the next six to nine months as the scar remodels and becomes stronger.
Chronic Regional Pain Syndrome This is unpredictable and occurs in a small percentage of patients that have surgery or injury. This is a reaction of the nerves and blood vessels. Anyone can get this despite good treatment. Some patients react to injury or surgery in this way and recovery can be prolonged and protracted. One may never recover completely.
Recurrence The fibres of dupuytens disease can grow back.
The patient is normally encouraged to use his hand after the operation and is required to wear a splint only at night. A therapist is usually assigned to look after the patient. Mr Khandwala will advise you on the time to start driving and getting back to normal activities.
It can be used for recurrences or in other areas of the hand but it may not be as effective for recurrence. Surgery is the preferred option.
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Mr Khandwala is available in Sussex, Surrey, Kent and the London area. Send request for a consultation about hand surgery.
Mr Khandwala appearing in national television.