Dupuytrens Disease

Dr. Steven Rueda is one of the most sought after doctors for Dupuytrens in Palm Beach. The condition is progressive in nature and requires careful followup from a hand specialist. It begins with lumps and pitting in the palms. There is subsequent development of contractures in the palm and fingers that show as tight bands in the direction of the fingers. As the disease progresses the finger joints become stiff and bent, therefore severely limiting the function of the hand.

Dupuytrens Disease Symptoms and Diagnosis

The symptoms arising from Dupuytrens are related to thickening of the tissues underlying the skin and fat of the palm. Some of the most common symptoms include:

 

  • Lumps in the palms
  • Pitting in the palms
  • Tight bands running in the direction of the fingers
  • Stiff hand and finger joints

In some cases patients present with all of the symptoms, and in some cases only with some of them. Lumps and pitting are initial findings that do not require treatment. However, once there is joint stiffness and limited motion treatment is important to regain function.

The diagnosis of DUPUYTRENS is usually performed by clinical examination and history. Diagnostic imaging is rarely needed.

WHAT CAUSES Dupuytrens Disease?

There is no one known cause for Dupuytrens, but rather several factors are thought to contribute to its development. The condition arises from abnormal thickening and contracture of the tissue below the skin and fat of the hand. This tissue is called the “palmar fascia” and extends throughout the palm and fingers. It is commonly seen in patient’s with northern European descent and was frequently seen in the Vikings. It is also more frequent in patients with diabetes.

Dupuytrens Disease Treatment Options

There are three main ways to treat Dupuytrens Disease: Xiaflex injection, needle fasciotomy, and open surgery. Splints are not effective in preventing progression of the contracture.
Xiaflex injection is a relatively recent form of treatment for patients with Dupuytrens disease. It contains a substance called “collagenase” that helps break up the thickened diseased layer in the palm that causes the contractures. The substance is injected in the diseased tissue with the use of a syringe and a needle. The medication is allowed to break down the diseased layer for 24-48 hours. The patient then returns to the office and the finger is stretched back to its normal position. It is best used on patients who have a single affected finger and a well defined contracted tissue band. Its main advantage is that it does not require surgery. Its disadvantages are the prolonged swelling of the treated area, increased rate of recurrence, risk of creating open wounds after manipulation that require dressing changes, and potential for tendon rupture from inadequate injection. Dr. Rueda avoids this risks by using ultrasound guidance to place all his injections in the perfect location.

Dr. Rueda performs Dupuytrens surgery using needle fasciotomy and open surgery. Needle fasciotomy places a needle through the skin of the palm in multiple locations and breaks up the affected deep tissue without the need of an incision. It is usually done in the office under local anesthesia or in the operating room under twilight sedation. It has the shortest recovery time of any of the alternatives including open surgery and Xiaflex injection. It has a lower recurrence rate than Xiaflex injections, but higher than open surgery. Its main disadvantage is the potential risk of damage to underlying tendons and nerves since its done through the skin without visualizing the underlying structures.
Open surgery on the other hand, works by physically removing the diseased tissue in the palm. It has the lowest recurrence rate of all the previous procedures. Its main disadvantage is a prolonged recovery time and the need for incisions in the hand that need to heal. Although there is still risk of damage to tendons, arteries, and nerves, it is less likely given the structures are visible during the procedure.

Dupuytrens Disease Procedure

There is no better surgery than others, and Dr. Rueda chooses the best procedure for each patient individually depending on current situation, need for fast recovery, and long term goals.

Incisions

Needle puncture sites along the course of the tight band spaced by 0.5-1.0cm

Incisions

Made vertically along the course of the tight band in a zig-zag pattern

RECOVERY AND DOWNTIME

• Needle Fasciotomy: Outpatient procedure. Most patients are actually surprised at having less pain that they expected. There is tightness, swelling for the first few days after surgery. A splint is applied removed in 5 days. The patient then begins therapy to gradually increase the movement in the fingers immediately after splint removal.
• Open Fasciectomy: Outpatient procedure. There is tightness, swelling for the first two weeks after surgery. A splint is applied removed in 5 days. The patient then begins therapy to gradually increase the movement in the fingers immediately after splint removal.

• Needle Fasciotomy: Most patients return to work in 5-7 days after the procedure. Weight lifting and manual exercises are avoided for 3 weeks.
• Open Fasciectomy: Most patients return to work in 2 weeks after the procedure. Weight lifting and manual exercises are avoided for 4-6 weeks.

Why Choose Precision Hand Center for your Dupuytrens Disease Procedure?

Dr. Rueda, a Hand Fellowship trained surgeon who has 7 years and 2,000 procedures of experience will be your safe and best choice for Dupuytrens treatment. Successful results in this procedure requires a surgeon that is experienced and knowledgeable in hand surgery and hand anatomy. Dr. Rueda has published articles in expert peer reviewed journals and his work has been presented in several national conferences. Dr. Rueda’s passion for patient education and custom centered approach will guarantee you feel comfortable every step of the way. Dr. Rueda also believes in treating his patients as if he was treating his own family; you can trust you will enter a trusting and long-term relationship and have some of the best Dupuytrens treatment Palm Beach can offer.

FREQUENTLY ASKED QUESTIONS (FAQ)

Patients with progressive contracture of the joints that limits daily activities are good candidates for procedural intervention.

It is common to have recurrence after Dupuytrens disease surgery. The lowest rate of recurrence occurs with open surgery, followed by needle fasciotomy. The recurrence rate after Xiaflex the highest, with most patient’s presenting with persistent symptoms at 2 years.

For Xiaflex the main risks are swelling, redness, and open wounds. Fortunately, open wounds heal well and quick with dressing changes. For the surgical alternatives the main risks remain damage to tendons, nerves, arteries and veins that are entrapped on the diseased tissue.