I just came back from a dinner party where the host was raving about his success with injections for his Dupuytren’s. I have the same hand problem but I’ve been told surgery is the best way to go. Is there anything to this injection treatment?

Patients who have a hand condition called Dupuytren’s contracture have three basic treatment choices. They can have an open partial fasciotomy (removal of the tissue), needle aponeurotomy (destruction of the connective tissue), or collagenase injection (needle injection of enzymes that break down the tissue.

Dupuytren’s contracture is a fairly common disorder of the fingers. It most often affects the palm side of the ring or little finger, sometimes both, and often in both hands. 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. Dupuytren’s contracture transforms the fascia into shortened cords.

As a result, a thick nodule (knob) or a short cord in the palm of the hand slowly forms, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytren’s contracture usually affects only the ring and little finger. The contracture spreads to the joints of the finger, which can become permanently immobilized.

The best treatment choice may depend on the patient. For example, open partial fasciectomy has been the standard treatment approach for a long time. But studies show that the recurrence rate is 30 per cent in severe disease and complications (e.g., wound infection, nerve damage) are common.

Needle aponeurotomy is an alternative treatment but the recurrence rate is even higher (60 per cent) than for open partial fasciectomy. The collagenase injections are fairly new and gaining in popularity but we don’t have studies yet to show how the results compare. Right now, the injections are used most often for single digit/single joint problems.

According to a recent study using cost-analysis to evaluate these three treatment approaches, health economics suggests using collagenase injection as the first-line of treatment. If the problem comes back, open partial fasciectomy could be tried. But there’s nothing to say needle collagenase in the treatment of any recurrence wouldn’t be just as effective. Future studies are needed to sort this out.