DEAR DR. ROACH: I have had two operations — one on each hand —involving the little finger for Dupuytren’s disease. There is a new procedure to correct this disease, called Xiaflex, which is a solution that is injected into the finger or the palm of the hand. This sure would be more appealing to me than the surgery.
I am of Scandinavian descent, and I understand it is hereditary. My father had it, and I am concerned for my children.
Could you please offer your comments on this disease and alternatives to hand surgery? Is there anything that can be done to prevent this problem? — J.N.H.
ANSWER: Let’s give a little more information for those unfamiliar with the problem. Dupuytren’s contracture, also called Dupuytren’s disease, is fibrosis of the palmar fascia, the strong connective tissue that helps protect the tendons and bones of the hand and hold them in place. Early on, nodules of the thickened tissue can be felt in the hand. Without treatment, and over time, the fibrosis progresses to the point where the tendons can get stuck in a flexed (closed) position.
Stretching and moving exercises can help prevent or delay its progression, as can local injection of steroids.
You’re correct in thinking that it is common in people of Northern European ancestry, and as many as 68 percent of male relatives of affected people will get the condition. Avoiding excess trauma to the hand seems to be the most important aspect in prevention, with the usual caution that cigarette smoking and alcohol consumption increase the risk -- in case you needed yet another reason not to smoke or drink to excess.
I read the information that the manufacturer provided about Xiaflex, and it convinced me that only an expert (a hand surgeon) should be having the discussion about possibly using this medication versus surgery. It is designed to dissolve the fibrous tissue.