Dealing A Straight Hand

A potentially troublesome condition in the palm and fingers can be treated with a minimally invasive procedure

Ask a historian what Ronald Reagan and Margaret Thatcher had in common and you will receive a substantial lesson in political power in the 1980s. What you may not hear about is Dupuytren's contracture, a unique disease from which both iconic leaders suffered. Dupuytren's contracture is a tightening of the tissue beneath the skin of the palm. It is a benign condition, but it can cause permanently bent fingers.

"There is a sheet of tissue under the skin of the palm, called fascia, which reinforces the skin of the palm," explains orthopedist Benjamin D. Sutker, MD. "The fascia looks like cloth and has fine threads which run length-wise from the palm into the fingers. Dupuytren's disease makes these length-wise threads shrink, and they become too short to let the fingers straighten all of the way."

An attempt to straighten the fingers pulls the threads taught, creating a Dupuytren's cord. This taught cord holds the fingers bent like the string on a bow.

"The cord may feel like a tendon but it is actually between the tendon and the skin," Sutker says. "Firm bumps in the skin of the palm, known as Dupuytren's nodules, may form along the cord."

There are other causes for bent fingers, including arthritis, "trigger finger" or the after-effects of an injury. For patients who do have a progressive Dupuytren's contracture and find their quality of life being affected, Dr. Sutker can offer an alternative to traditional open surgery.

"Needle aponeurotomy is a minimally invasive treatment for Dupuytren's contracture," Sutker says. "The advantage of needle aponeurotomy is the quicker recovery of 2 to 7 days as opposed to 2 to 3 months for traditional surgery. Postoperative therapy is not usually needed and the procedure can be repeated in a very straightforward fashion if there is possible recurrence. In most cases it is possible to return to near normal activities without bandages within a few days of treatment."

The procedure takes approximately 30 minutes, and is done under local anesthesia. After anesthetizing the skin, the physician uses a small needle both to cut the tight fascia and to inject Dupuytren's nodules with cortisone. After the procedure, the injections sites are merely covered with Band-aids, a small ice pack is applied, and patients are encouraged to elevate the hand as much as possible for 48 hours.

"Most patients are able to eat, change clothing, go to the restroom and drive a car without assistance immediately after the procedure," Sutker says. "Patients are advised to avoid gripping a golf club, tennis racket or carrying heavy objects for 7 to 10 days. Pain medication is rarely required and most patients do very well with an occasional over-the-counter anti inflammatory, such as Ibuprofen or Aleve."

Dr. Sutker is the only physician in this region who performs this procedure, and one of only two physicians in Georgia. Studies have shown that 50 percent of patients will have some form of recurrence of Dupuytren's contracture about three years after needle aponeurotomy, but none of Sutker's patients have gone on to have open surgery.

"Needle aponeurotomy can be repeated at intervals if there is a clinically significant recurrence," Sutker says.

The feedback that Dr. Sutker has received from patients he's treated with this procedure has been tremendously positive.

"I've had the opportunity to perform this procedure on patients who have had prior open surgery on the opposite hand," Sutker says, "and they overwhelmingly prefer the needle aponeurotomy."

What's that name again?

Dupuytren's contracture is named after Baron Guillaume Dupuytren, a French surgeon who described the condition and treatment in the 1830s.

Because the condition is most common in individuals of Northern European descent, it has been called the "Viking's disease."
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