Harvard Women's Health Watch

In the journals: Nonsurgical approach unlocks contracted fingers

In the journals

Nonsurgical approach unlocks contracted fingers

A study in the Sept. 3, 2009, issue of The New England Journal of Medicine (NEJM) reports a new treatment for Dupuytren's contracture, a disabling condition of the hands that results in chronically bent finger joints. The condition develops when abnormal scarlike tissue in the palm causes the hand to contract, leaving one or more fingers bent inward. The new treatment, developed by researchers at the State University of New York (SUNY) at Stony Brook, involves injections of an enzyme called collagenase clostridium histolyticum — a technique that had been tested with good results in earlier, smaller studies. As we go to press, the drug is awaiting FDA approval.

The standard treatment for severely limited hand function caused by Dupuytren's contracture is surgery to remove or mechanically break up abnormal tissue. But recovery from surgery often takes a long time and may involve extensive rehabilitative hand therapy. Because of age or complicating health conditions, some people can't tolerate the surgery itself or the lengthy recovery period and associated physical therapy. Various complications can also occur, including nerve injury and loss of grip strength. Although tendon rupture is rare, surgery has relatively high rates of complications — up to 8% for nerve injury, 10% for artery injury, and 11% for infection. And even after successful surgery, recurrence is common.

According to the authors of the NEJM study, rehabilitative therapy isn't needed after collagenase injection, and the side effects have generally been mild. But the study was too short to judge the risk of recurrence.

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