Options to treat fingers that contract

My finger is contracting up, but is not painful. What are the options for treatment?

This is a common complaint in the older population and the diagnosis is often Dupuytren's contracture. It can affect both hands and usually begins as a small lump or pit in the palm. With time (weeks to months), a cord may form and progress toward the finger, noticed when the palm cannot be placed flat. More than one finger may be involved. Severe contractures can interfere with daily activities.

The disease process is an abnormal thickening of the palmar fascia, a layer of tough tissue between the skin and flexor tendons. The nodules are usually painless, but can be painful at the onset. Most commonly, the pinky and ring finger areas are involved, but any finger may be affected, including the thumb. Occasionally, there will be knuckle pads (on the tops of the fingers), which are called Garrod's nodes. Other fascial thickenings related to Dupuytren's disease occur on the sole of the foot (Lederhose's disease) and the penis (Peyronie's disease).

The cause of the disease is unknown, but certain conditions have been associated with it. The disease usually affects individuals of northern European ancestry and is more common in men over 40. In most cases, the disease is hereditary, but may be associated with trauma, seizure disorder, diabetes and alcohol abuse.

Nonsurgical treatment is indicated for those patients with only the palm involved. Any contracture of the metacarpophalangeal joint may be corrected with surgical or enzyme injections. However, proximal interphalangeal joint contractures are usually not fully correctable. Therefore, treatment is indicated for any impending or current proximal interphalangeal joint contracture, and for a metacarpophalangeal joint contracture that interferes with the patient's daily activities.

There are several treatments available. Surgery had been the mainstay of treatment until recently. Needle aponeurotomy (cutting the cord with a needle) has become more common, and is typically performed under local anesthesia as an office procedure. Earlier this year, an injectable enzyme was FDA-approved. This is a collagenase that dissolves a portion of the cord and allows gentle manipulation of the finger until it straightens, about 24 hours after the injection. This is also an office procedure, but is not widely used yet.

Patients must understand that contractures may recur, even in the areas of previous excision, and can occur in any area of the hand, no matter which treatment is selected. Skin grafts may be required, especially for recurrent cases. The goal of any treatment is improved hand function while minimizing risks.

source: news-journalonline