Non Surgical solution to Crooked Fingers
Take a look at your palm right now to see and feel if you have a palm nodule or a fibrous cord. What you are looking for is a lump or a hard cord under your palm or finger skin. Many people from Eastern and Northern European heritage have to a 60% chance of developing this benign condition. But any ethnicity can develop a finger that is flexed and won’t extend, which is called a flexion contracture. If your relative has such a condition that also gave them a crooked finger, you may have a family risk of Dupuytren’s contracture. If you do have early palmar fibrosis it may take a long time to progress to anything that inhibits your daily hand function. And not all cords need treatment or surgery, unless they progress to contract your fingers or palms.
What is new about the treatment of this debilitating condition is the use of an enzyme called collagenase. Collagen is the protein building block of all connective tissue found in the human body, collagenase destroys the chemical bonds in collagen. Scientists in Australia used two kinds of purified collagenase from a sterile source to create a drug to dissolve the cords that caused the contractions found in the fingers and palms of people who have Dupuytren’s disorder.
This drug, named Xiaflex, came on the market after years of successful use in Australia, and finally met with FDA approval in February of 2010. I first used collagenase in the laboratory when I worked at the Medical College of Pennsylvania, doing electron microscope research in protein chemistry. As I watched that scientific literature progress through the lengthy FDA approval process, I knew I would adopt this new use of existing bio-technology to help my patients. I was lucky to be one of the early hand surgeons to use this drug, saving my patients a lot of surgery.
The drug comes to me as a dry frozen pellet. I reconstitute it a few minutes before use, as it quickly degrades. It is injected into the finger cords, which pinches a little. Some swelling or bruising at the injection sites can occur. The hand is then dressed and left alone for the day. When I see the patient the next day, I give them a shot of local anesthetic so I can do what is called an extension procedure. That means I manipulate the finger to break the collagenase weakened cord, allowing the finger to achieve normal range of motion. The results can be dramatic and rapid, liberating a finger that often hasn’t moved for years!
Shrinking skin is common complication of a finger stuck in flexion contracture for so long. So sometimes when I extend the stuck finger, there is not enough skin to allow it to reach its full range of motion. I caution some patients that they may need a little skin graft if that happens. Sometimes we can just dress it with gauze and Neosporin® and allow the skin to just heal over the next 3 weeks or so.
A Norwegian study found that over 30% of patients over age 60 developed flexion contracture. Diabetes and alcohol intake were once thought to be factors associated with Dupuytren’s contracture, but more recent epidemiological studies have shown no such association. I have seen men and women of a broad range of ages that have sought my opinion about Dupuytren’s contracture. They have all responded to initial injections. Patients can have up to three injections in each joint spaced out a month apart. The risk of the injection into the cord is that the drug can go into the tendon and dissolve it – the collagenase doesn’t know the difference between tendon and Dupuytren’s cord. But that is the reason that the manufacturer only allows hand surgeons to administer the drug. The recurrence for the cord after injection is the same as the recurrence after surgery.
And remember…Think Health!