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Definition & Overview

The palmar fascial cord is a type of connective tissue in the palm of the hand. If the cord is affected by a disorder, such as Dupuytren’s contracture, it thickens and causes the palm of the hand and one or more fingers to contract. The exact cause/s of the disorder is yet to be identified, but treatments are available for the condition. Dupuytren’s contracture is a disease that develops over a long period. It is characterised by the palm and fingers of the hand being slowly drawn inward. This is a direct result of the thickening connective tissue in the palm. Other symptoms of the disease differ from person to person. For example, it can be a painful condition to some people, while others may not even know they are affected, aside from noticing the visible symptoms of the condition. Doctors do not require complex tests to diagnose the condition. A simple physical examination of the hand and evaluating if the patient can place his or her hand flat on the table should be enough to diagnose Dupuytren’s contracture. The disease may develop over a long period of time, but it does so in stages. In the first stage, pain or discomfort can be felt in the palm and/or small and ring fingers of the hand. This stage is referred to as the proliferative phase. As the disease progresses into the involutional phase, the palmar fascial cord begins to tighten and becomes a bit noticeable. In the final stage, called the residual phase, the cord contracts resulting in the palm forming like a cupped hand. In this stage, the patient will find it difficult, if not impossible, to lay the hand flat on a table. Dupuytren’s contracture can be treated using a variety of methods. One method is to puncture the cord using a needle to release the contracture. The cord may contract again in the future, but the procedure can be repeated as needed. Another method is to perform surgery to remove the cord and tissue affected by the condition. The results are long lasting, but therapy is usually required after the procedure. One method that is gaining popularity is injecting the affected area with a collagenase enzyme called Clostridium histolyticum. The enzyme weakens the cord to a point where the doctor can break it and straighten the hand and finger/s.

Who Should Undergo & Expected Results

As mentioned earlier, the Dupuytren’s contracture may or may not cause pain. However, there will be clear signs of the condition. Patients who notice a visible deformation of their hand and/or finger without any obvious cause should consult their doctors. The doctor will then present various treatment options and recommend a particular method. If the patient does not wish to undergo surgery for whatever reason, the injection of the collagenase enzyme might be the best option. The enzyme will then slowly break down the thickened connective tissue, softening it in the process. As a result, the doctor should be able to break the tissue and return the finger to its normal condition. However, the results may not be permanent. Should the cord tighten again, the procedure will need to be repeated.

How Does the Procedure Work?

Prior to the procedure, the doctor must first diagnose the condition as Dupuytren’s contracture. The only test that is usually required for diagnosis is a physical examination of the hand. The doctor may also request information on the patient’s current medical condition, medical history, when the symptoms were first noticed, and if the condition is accompanied by other symptoms, such as pain. A couple of decades ago, surgical intervention was usually the recommended method for treatment. However, the development of the collagenase enzyme led to a less invasive procedure. If the patient agrees to the injection, the enzyme will be injected to the palm of the hand, precisely at the affected area. The enzyme is not injected into the fingers because of the damage it can cause. After the first injection, the patient should be able to notice an improvement. The procedure may be repeated after a certain period for improved results.

Possible Risks and Complications

Any medical procedure has associated risks and possibility of complications. In this procedure, adverse effects are common, but do not result in long-term damage or discomfort to the patient. Such adverse effects include pain, bleeding, and discomfort at the injection site. It is also possible for the patient to develop complications that are more serious, such as a ruptured tendon and a condition called complex regional pain syndrome. But serious complications rarely occur. Although injecting collagenase enzyme to treat the condition is considered highly effective, the results are not immediate. It may take some time for significant results to occur. During this time, the patient will need to avoid injuries to the hand. Patients should also be aware that the results might not be permanent. In time, the condition may reoccur or may even seem to worsen. When this happens, the procedure may be repeated or the doctor may recommend another treatment option, such as surgery.

References:

  • Hindocha S, McGrouther DA, Bayat A. Epidemiological evaluation of Dupuytren's disease incidence and prevalence rates in relation to etiology. Hand (N Y). 2009 Sep. 4(3):256-69. [Medline]. [Full Text].
  • Meathrel KE, Thoma A. Abductor digiti minimi involvement in Dupuytren's contracture of the small finger. J Hand Surg Am. 2004 May. 29(3):510-3.
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