Break-Through Hand Treatment

Dupuytren's Contracture
Dupuytren’s contracture is a progressive condition that affects the connective tissue in the palm of the hand. The condition occurs when knots of tissue form under the skin, eventually creating a thick cord that can pull one or more of the fingers into a bent position. Once this cord develops, the fingers contract and hand function is impaired. The fingers affected by Dupuytren’s contracture can no longer be straightened completely, making it difficult for patients to have normal hand function.

“This condition makes everyday activities very difficult for patients,” says Mark Belsky, MD, Hand Surgeon and Chief of Orthopaedics. “Since Dupuytren’s contracture limits the patient’s ability to open his or her hand, this condition affects the ability to perform daily functions. Though the condition is rarely painful, the bumps of tissue on the palm can be sensitive to touch. When the bumps appear on the back of the fingers, they often hurt.”As the disease progresses, it may result in deformity and loss of function of the hand. Up to this point surgery has been the only effective treatment for Dupuytren’s contracture; however, through recent research hand surgeons are now able to offer an injection to treat this condition.

“Newton-Wellesley Hospital was selected as one of 14 centers to be involved in the recent research to develop an alternative to surgery for treating this condition,” says Dr. Belsky. “I was chosen along with my partner Matthew Leibman as the primary investigator after I applied to have the Hospital participate in the national study. It was very rewarding to see patients benefit from this new treatment.”

New Enzymatic Treatment
The new procedure, performed in the office, is an injection treatment that administers a few drops of a new enzyme through a very tiny needle directly into the cord. The research study was published this year in the New England Journal of Medicine.

“The enzyme actually breaks down the collagen cord that has developed,” says Dr. Belsky. “The patient comes in the next day to have the cord ruptured by the physician, which allows the fingers to straighten.”

During this visit, a local anesthesia is used to prevent the patient from feeling any pain from the rupture. They are then fitted with a splint by a hand therapist to be worn at night. In most cases, a patient needs one or two injections to completely straighten the finger.

“This new enzymatic treatment will replace much of the open surgical procedures that are done for patients with single cords. This treatment will be more attractive for patients in earlier stages of the disease,” says Dr. Belsky. “This is currently the only drug approved by the U.S. Food and Drug Administration for the treatment of Dupuytren’s contracture.”

Candidates for the Procedure
The most frequently affected parts of the hand associated with this condition are the metacarpophalangeal (MP) joint – the closest finger joint to the palm of the hand and the proximal interphalangeal (PIP) joint – the middle joint in the finger. The little finger and ring finger are most frequently involved.

“Patients with contractures of at least 20 degrees at the MP joint and any contracture at the PIP joint where the contracture interferes with their hand function are candidates for the new injection,” adds Dr. Belsky.

Most cases of Dupuytren’s contracture occur in patients older than 40 years and the incidence is highest in Caucasians, historically those of Northern European descent.

Less Pain, Less Costly
“This non-operative injection technique is much easier on the patient,” says Dr. Belsky. “They will return to using their hand normally earlier than with surgery, there are no sutures to remove and after the first few days of swelling after the injection, they will have less pain.”

The procedure also helps reduce health care expenses as it costs less than surgery. The total cost of the injection and manipulation is much less than the cost of surgery, which includes costs for the operating room and recovery.

Patients interested in this less invasive procedure should be evaluated by an experienced hand surgeon to determine if they are candidates for the injection.

“The FDA approval of this injection is a major breakthrough for patients suffering from the debilitating effects of Dupuytren’s contracture,” says Dr. Belsky. “Using this new procedure will help our patients regain their quality of life – and return to the activities they enjoy!”

Hand Therapy Service
The hand surgery specialists affiliated with Newton-Wellesley make up one of the largest hand surgery services in New England. They provide care for conditions from the elbow to the fingertip such as fractures, joint injuries, carpal tunnel syndrome, arthritis, tendonitis, trauma, tennis elbow and congenital deformities.

The Hand Therapy Service team in the Rehabilitation Services Department is made up of physical and occupational therapists who are board certified hand therapy specialists. The team delivers timely, expert care to a variety of elbow and hand conditions and serves as a critical component of the hand surgical services at the Hospital. They work to evaluate and treat these conditions and allow patients to regain essential hand function.

Members of the team design and fabricate splints for the upper extremities on site and have professional expertise and experience in the evaluation and treatment of tendon and nerve injuries, lacerations, repairs and transfers; joint reconstruction and replacement surgery; arthritis; fractures; soft tissue injuries; tendonitis; and repetitive strain injuries.

“Hand therapy is a critical component for patients in determining a successful outcome following hand surgery, hand treatments, or hand injury,” says Mark Belsky, MD, Chief of Orthopaedic Surgery. “Our hand therapists provide unique specialized and compassionate care to our patients.The hand surgeons on our staff work closely with our hand therapists to plan the necessary comprehensive care for our patients. Our physicians and our patients are very fortunate to have such a high caliber of hand therapists here at the Hospital.”