Dupuytren’s contracture is a condition in which one or more fingers curl in toward the palm. The victim may be completely unable to open the hand and this can eventually lead to a permanent disability. The usual treatment is surgery and extensive post-surgical hand therapy. Even with this, however, the condition may recur.
A study in The New England Journal of Medicine suggests that there may be a different way to treat this problem. The investigators injected an enzyme that breaks down collagen in the affected finger. The lead author describes the treatment as an enzymatic knife that weakens the toughened tissue that has caused the contracture. In the study, the enzyme worked for nearly two thirds of the fingers treated. The placebo only worked for 9 percent. There were side effects, such as pain at the injection site, swelling and bruising. Nevertheless, this approach represents a whole new way to treat Dupuytren’s contracture. If it holds up, the enzyme may be tested in other fibrotic conditions such as frozen shoulder syndrome and Peyronie’s disease in which the penis bends to the side.
[New England Journal of Medicine, Sept. 3, 2009]

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  1. RetiredOF
    Reply

    I had surgery for Dupuytren’s contracture on both hands about 30 years ago. The first attempt on the right hand was botched and had to be re-done. Since then my left hand has gotten bad again in the middle, ring and little finger. When I place my hand on a flat surface the inside of my palm is nearly 1.5 inches off the surface and cannot be flattened. The right hand is still pretty flat.
    I am a bit excited about Xiaflex since I also suffer from frozen shoulders (both left and right). If we’d say normal ability to raise an arm straight up is 180 degrees, mine is no more than 120. It’s not fun trying to get stuff off the top shelf.
    Does anyone know of testing on the frozen shoulder problem. My condition was diagnosed about 40 years ago. Steroids didn’t help and I even tried manipulation under sedation. The doctor told me he jerked my arm as much as he could without breaking it, but it never got loose.

  2. John M.
    Reply

    I’m 52, and I live in Canada, and I just finished physical therapy on my left hand, as I had the operation performed on Jan.3, and now the hand is as good as it’s ever going to get, so the Occupational Therapist who was assisting me told me to stop wearing the splint, and I asked her if I should just throw it in the garbage now, and she said that I might as well, because this is it, I’ve hit the heights.
    I had the hand operated on four years ago for the first time, and it seemed to be improving for a while and then it started to looks worse, so the surgeon who performed the first operation did the second one too, and once again there was improvement in the ring and pinky finger of my left hand, and now it looks worse again.
    The reason I went to the doctor in the first place four years ago was because the disease was really affecting my guitar playing, and that’s why I wanted to find out what was going on. I was visiting some friends just before Christmas, and they asked me to pick a couple of songs, as a couple of people heard me play before, so I grabbed one of the guitars and gave it a shot, but I couldn’t even make a D chord on the guitar.
    My ancestry is 100% Scottish, and there are quite a few older people on both sides of my family who experienced what the disease will do, and I’ll be 53 in October, so I’m not going to try playing guitar anymore, and will just listen to music instead, because music has always been a big part of my life.
    I started playing drums when I was 12 and switched to guitar when I was 16, so maybe I’ll start playing the drums again, because I can do that, and I can still type, which is VERY important to me, so I think I’ll be okay. Things would be a lot worse for me if the disease was cancer, and that’s on both sides of my family too, so I think it’s time for me to stop thinking about my left hand.

  3. J. G.
    Reply

    Four weeks ago I severed my ulnar nerve. I had surgery to reattach the nerve and my arm was in a cast from above the elbow down to my fingers for three weeks.
    The cast was removed a week ago. My arm, wrist and fingers are still very swollen. My middle, ring and little fingers are clawed and I am unable to even start making a fist or lay them straight. Clarification: my middle finger has been clawed since trigger finger surgery several months ago.
    The out side of my right arm is swollen and aches, my wrist is still swollen and hurts when I try bending it, my last two fingers are numb and clawed, the middle finger is clawed and hurts when I bend it.
    The only instruction I received from the doctor was to keep trying to make a fist and then flattening my fingers on a table but pushing the fingers flat is necessary.
    I asked about squeezing a soft ball and was told not to use one, just keep making the fist. He didn’t mention any further physical therapy or splinting for comfort. I’m just not sure if it’s normal to be so swollen and hurting whenever I move my arm, wrist, hand and fingers even the slightest bit.
    What is my recourse at this point? Thank you very, very much for your thoughts and suggestions.

  4. csm
    Reply

    Consider using trigger point therapy on yourself first to see if you can avoid surgery. This involves massage of tight areas in muscles leading to the Dupuytren’s contracture. It may take a few sessions of massage but is certainly worth considering.
    Here’s a link to a good book for self care of musculo-skeletal problems:
    http://books.google.com/books?id=IYqqY5Ae_VoC&pg=PA125&lpg=PA125&dq=TRIGGER+POINT+THERAPY+DUPUYTREN%27S+CONTRACTURE&source=bl&ots=wOhhYxBxB6&sig=eOkpnYWHXyRwfhvnB_QawWemPjw&hl=en&ei=Vj20Su-AAouwtgfn9einDg&sa=X&oi=book_result&ct=result&resnum=1#v=onepage&q=TRIGGER%20POINT%20THERAPY%20DUPUYTREN%27S%20CONTRACTURE&f=false
    Most of the book is available for browsing on the web.

  5. dwd
    Reply

    Would this work for hammer toe? I have found relief with massaging and stretching my toes and warm foot baths, and my podiatrist showed my wife a way to tape them down to prevent curling. Seems like this enzyme might work for toes as well a fingers. Has there been any research?
    PEOPLE’S PHARMACY RESPONSE: WE ARE UNAWARE IF THIS ENZYME HAS BEEN TESTED FOR HAMMER TOE.

  6. Jean
    Reply

    Hi, For what it is worth, I had one finger on my left hand turning down a bit a few years back and since we have been practicing “QiGong”, I recently realized that it is no longer happening and hasn’t for a few years. My husband and I include massaging each finger and nail bed and palms of our hands at different moments to massage the many, many acupuncture points we have in hands. This can be done while sitting watching TV or listening to the radio or any time convenient. We also are huge advocates of taking Reishi (Ganoderma Lucidum) via our coffee.

  7. Paula
    Reply

    I have dupuytren’s contracture also known as Vikings Disease. I have traced my family to England where they could have intermarried or mated with Vikings when they went to England.

  8. DGR
    Reply

    I have this in the bottom of my feet and I hope this works out.

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