hand surgery - Dupuytren's Fasciectomy, Hand Microsurgery and Arthritis Surgery

Hand Surgery Procedures:

Collagenase Injections

Dupuytren's Fasciectomy

Needle Fasciotomy for Dupuytrens

Arthritis of the Hand and
Joint Replacements

Rheumatoid Arthritis
of the Hand

Osteo-arthritis of the Hand

Fractures, Dislocations
and Tendon Injuries

Microsurgery to Reconstruct
or to Re-implant
Severed Parts

Bone Grafts for Bony Defects

Nerve Reconstruction -
Nerve Damage
Reconstructed by Repair

Nerve Graft for Tendon Transfers

Carpal Tunnel Syndrome

Cubital Tunnel Syndrome

Skin Cancer of the Hand

Rejuvenation of the
Aging Hand

NRAS logo

BSSH logo

BAPRAS logo

ARC logo

DUPUYTREN’S CONTRACTURE: Treatment with Collagenase Injections

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.

Collagenase Injections

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.

Aftercare following Collagenase injections

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.

Can Collagenase injections be used again?

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.

Ask a Question

Hand surgery can raise many questions. In case of any enquiries, find details above to contact Mr Khandwala. Alternatively, fill in the form to send and enquiry.

Consultation

Mr Khandwala is available in Sussex, Surrey, Kent and the London area. Send request for a consultation about hand surgery.

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