New Dupuytren’s Contracture Treatments

New Dupuytren’s Contracture Treatments – A Discussion with Dr. J. Michael Bennett & Dr. Alan Rodgers

This is a summary of a segment of the Dr. Jay Show covering new Dupuytren’s Contracture treatments.  The Dr. Jay Show was broadcast on AM 1560TheGame. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician serving patients from Katy,Fort Bend County, Metro Houston and Southeast Texas from offices in Houston, near the Galleria and Sugar Land, TX. Call 281-633-8600 for an appointment. Our special guest for this show is Dr. Alan Rodgers, who is a hand specialist practicing in the Katy area.

Here’s the summary of the fourth portion of the Show:

Dr. J. Michael Bennett:  And speaking of hand deformities, we talked about arthritis and there are other types of hand deformities out there that people can have, and one of them is actually something called a Dupuytren’s contracture , which is a condition where basically you form these scar bands in the palm that actually can pull your fingers down to where you can’t really lift your finger up anymore, and result in a patient not having a very functional hand.  Now I know the old way of treating these Dupuytren’s contractures regarded a big release and a Z-plasty.  There’s another way, a newer way, where they’re doing injections.  Now just like anything else, with these new techniques there’s always issues with insurance companies, but tell us, Dr. Rodgers, a little bit about the injection in the hand itself and what your thoughts are on these contracture releases.

Dr. Alan Rodgers:  I am happy to offer the procedure, it is called Xiaflex, (a prescription medication used to treat adults with Dupuytren’s contracture, according to the Xiaflex website) and it is FDA approved for injection.  Any time you can feel what’s called a cord, and you’ll know if you have this, any time you look at your palm and you see a band of firm tissue that prevents you from opening your fingers fully, that is what can be treated. And it is a great procedure because it can actually be used before surgery is really indicated.  We really don’t like to do surgery on these until it’s affecting the fingers so much that you can’t put the hand flat on a table, have a hard time putting your fingers in a pocket, or you have a hard time shaking hands; in other words it’s really deforming the finger.

XIAFLEX™ (collagenase enzyme) injection for Du...
XIAFLEX™ (collagenase enzyme) injection for Dupuytren’s contracture. Before, next day, and two weeks after first treatment (Photo credit: Wikipedia)

The injection’s actually approved for when you first start noticing the firmness – it’s called palmer fascia, or scar tissue, as people refer to it – but you have to not be in too big a rush on this because we have to submit everything to the insurance company and wait for them to approve it.  And I guess to their defense the medication is expensive, it’s new, of course it is a proprietary medication – there is no generic equivalent, yet – but patients we have done have been very happy with it.  They don’t have to go to surgery, there’s no anesthesia risks, but it’s not just a simple injection and you’re done.  It is a two-day process, we inject the first day, the hand does swell, oftentimes bruises, pain people report is medium, mild to medium, and I do prescribe pain medication for that.  The next day we manipulate the hand, and under a little local anesthetic, right there in the office, we break the band and then you heal. And it has longevity results equivalent to surgery.  We don’t do splinting; you’re actually in a soft dressing right after surgery.  On severe cases, I will send them to physical therapy to have a night splint fabricated to have them keep their fingers in extension for at least the first few months after we arrange and break the cord.

Our office is part of the highly-regarded Fondren Orthopedic Group and we refer complex wrist and hand injuries to hand specialists at Fondren for treatment.  The Fondren hand surgeons are board certified and have added qualifications in hand surgery.

Dr. J. Michael Bennett treats certain wrist and hand injuries including carpal tunnel syndrome, distal radius fractures (broken wrist), trigger finger and metacarpal fractures of the hand.  He specializes in using the endoscopic approach to carpal tunnel syndrome, when appropriate for the patient, which means that the carpal tunnel surgery consists of two small incisions instead of a longer incision across the middle of the palm of the hand.  For treatment of these hand and wrist injuries, please call our office for an appointment in Sugar Land at 281-633-8600 and in Houston at 713-234-3152.

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