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I've written to you before about my Dupuytrens disease. Everything you've told me has been helpful. I'm checking back now because I heard there's a new treatment that involves injections, not surgery. Is this something I should try?

Dupuytrens disease is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. Although the exact cause is unknown, it occurs most often in middle-aged, white men and is genetic in nature, meaning it runs in families. The palm side of the hand is affected. This is where a type of connective tissue, called fascia that surrounds and separates the tendons and muscles of the hand is involved. Just under the palm is the palmar fascia, a thin sheet of connective tissue shaped somewhat like a triangle. This fascia covers the tendons of the palm of the hand and holds them in place. It also prevents the fingers from bending too far backward when pressure is placed against them. The fascia separates into thin bands of tissue at the fingers. These bands continue into the fingers where they wrap around the joints and bones. Dupuytrens disease causes tightening called contracture. When the palmar fascia tightens, the fingers curl into a bent position and stay there. The condition commonly first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytrens contractures usually only affect the ring and little finger. Almost 400 years have passed by since Dupuytrens disease of the hand was first described by a Swiss physician. Since that time, surgery has been the only successful treatment. That may all change with the recent FDA approval of Xiaflex, an injectable drug designed to weaken the diseased tissue. By injecting an enzyme directly into the cords formed by the disease, the tissue dissolves and starts to weaken. Then the surgeon can manually pull the fingers straight and rupture the cord. That sounds dramatic -- it's not! The treatment is safe and effective. Treatment of this type (called enzymatic fasciotomy) may eventually replace surgery. But further study is needed to assess the long-term effects, especially recurrence rates. Until then, surgical release of the cords will likely remain the gold standard. Check with your surgeon and find out what he or she thinks about the new injectable treatment for Dupuytrens. It's possible this treatment technique is available in your area should you want to consider trying it. Future studies will be needed to compare final results for different treatments. Conservative care with Xiaflex (or other similar) injections must be compared to surgical treatment. The various surgical approaches should all be included as well. Cost considerations among the different treatment options will have to be considered along with the long-term effects and recurrence rates.

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