tracture and to prevent disability in your hand. Treatment is determined based on the severity of the contracture.
Ongoing research of this condition has resulted a less invasive method of treatment called an enzymatic fasciotomy, if only the MCP joint is contracted, and there are only one or two cords involved, this procedure may be possible. It may eventually replace surgery. Until then, surgical release of the cords will likely remain the gold standard.
The U.S. Food and Drug Administration (FDA) recently approved a new injectable drug (Xiaflex) for nonsurgical treatment of this problem. By injecting an enzyme directly into the cords formed by the disease, the tissue dissolves and starts to weaken, most often he/she is able to break apart the cord himself/herself.
Generally patients return within 24 hours for recheck. If the cord hasn't broken apart, your physician may have to numb the finger and then stretch the finger to break apart the cord to regain full motion of the finger. That sounds dramatic -- it's not! The treatment is safe and effective. But further study is needed to assess the long-term effects, especially recurrence rates.
There are a few possible (minor) side effects but very few major or long-term complications with this new treatment. During the control trials conducted with patients, most people had a local skin reaction (swelling, redness, skin tears, itching or stinging) where the injection went into the skin. A small number of more serious problems developed in a few patients including skin infection, tendon rupture, finger deformity, complex regional pain syndrome (pain and stiffness), and hives that had to be treated with medication.
Early studies show a good success rate (77 per cent) in reducing MCP contractures using this injection treatment. Almost all of the patients (92 per cent) were able to straighten the MCP joints with less than a 30-degree flexion contracture. Results were not quite as good for the PIP joints. Less than half (44 per cent) of the patients with PIP contractures had regained full motion of the affected joint. The long-term results and recurrence rates with enzyme fasciotomy are unknown at this time.
No hard and fast rule exists as to when surgery is needed. But the sooner a contracture is treated, the better the results of a return to full function. Many patients are instructed to keep an eye on the disease and return for follow-up once their “tabletop test” shows light between their hand and the table.
Surgery is usually recommended when the MCP joint (at the knuckle) of the finger reaches 30 degrees of flexion. When patients have severe problems and require surgery at a younger age, the problem often comes back later in life. When the problem comes back or causes severe contractures, surgeons may decide to fuse the individual finger joints together. In the worst case, amputation of the finger may be needed if the contracture restricts the nerves or blood supply to the finger.
Surgery for the main knuckle of the finger (at the base of the finger) has better long-term results than when the middle finger joint is tight. Tightness is more likely to return after surgery for the middle joint.
The goal of tissue release surgery is to release the fibrous attachments between the palmar fascia and the tissues around it, thereby releasing the contracture. Once released, finger movement should be restored to normal. If the problem is not severe, it may be possible to free the contracture simply by cutting the cord under the skin.
A less invasive procedure called a needle aponeurotomy (also referred to as a percutaneous fasciotomy) is available when the disease is at an early stage. Under local anesthesia, the surgeon inserts a very thin needle under the skin. The sharp needle cuts a path through the cord, weakening it enough to stretch and extend or rupture it.
The advantage of this procedure is that it can be done on older adults who have other health issues that might make surgery under general anesthesia too risky. The disadvantage is a high recurrence rate and the potential f