Handy tips on hand disease Dupytren’s contraclure

Handy tips on hand disease Dupytren’s contracture

By Diane Atwood

About 12 years ago, Donald Jones ran into a friend who used to be a hand surgeon. When they shook hands, the friend felt a cord in Donald’s palm and told him that he had Dupuytren’s contracture.

Dupuytren’s means you can’t straighten some of your fingers, usually the ring and/or the little finger and sometimes the thumb. Donald knew what it was. His father had a contracture in one of his fingers.

“He didn’t do anything about it until his finger curled over and grew right into his palm,” said Donald. “He had to have major surgery. They had to cut the cords in his hand to open up his fingers.“

How Dupuytren’s develops

Underneath all skin, including on the palm, is a sheet of connective tissue, the fascia. With Dupuytren’s, the fascia becomes diseased. The first sign is usually a small nodule or a bump in the palm, says Dr. Youssra Marjoua, a Portland orthopaedic surgeon and hand specialist.

“It may feel like a callous,” he said. “There’s no pain, but it continues to evolve into a cord. The cord doesn’t immediately contract, but eventually will attach to the skin above. As that happens, it starts to actually bring the skin down and leads to a flexed finger.”

The highest prevalence is in senior Caucasian men, mostly of northern European descent. They usually have a family history of the condition.

Donald’s progressed slowly in both ring fingers.

“I would shake hands and it would feel funny,” he said. “Your finger has curled over and you can’t even force it back. “

In April, he had a procedure to release the cords and his bent fingers, first in one hand and a month later, the other. He could have opted for surgery to remove the diseased fascia, but instead, had an enzyme, Xiaflex, injected into the cord. The enzyme softens and weakens the cord so that in a day or two it’s possible to break it up by stretching and bending the finger. In one finger, Donald inadvertently did it on his own.

“I had the shot one day and the next day I was shopping, I grabbed the door of the bottle return to drop the bottles in and I felt it pull a little bit. When I went in that next day to have it stretched, he said, ‘Oh, you already did it.’ So that pulling already stretched it some and then he did the rest.”

Donald says he’s glad he had the procedure done because his fingers are no longer bent. But he still has a bit of trouble opening jars and there’s a chance he’ll have another procedure in the future on his little finger, which has a cord.

Deciding how or if to treat

Marjoua says it’s difficult to predict the severity of the disease. Just

CU picture is Donald demonstrating how his father’s finger looked.

because there is a nodule, or even a cord, doesn’t mean the finger will bend. To make a diagnosis, in addition to asking questions and examining the hand, the doctor will do a tabletop test, where the patient puts his hand palm down on a table. If all fingers and the entire surface of the palm can be flat without any gap, it usually means the contraction doesn’t need intervention.

How Donald’s finger looked before procedure.

If treatment is necessary, two factors should be considered before choosing surgery versus an injection.

First: Is there a clear palpable cord that medicine can be safely injected into? The medicine must only go into diseased tissue and not in the tendon or surrounding arteries and nerves.

Second: If it’s so severe the patient has a finger and palm deformity and the cord can’t be seen, surgery is an option.

Submitted photos

He’s pointing to the cord in his hand that indicates he MAY develop another contracture.

Some can choose between surgery or injection. In surgery, because the diseased fascia is removed, there is less chance of a recurrence, but it usually can’t be totally removed, so it doesn’t eliminate the risk. Either way, there is no easy way to predict a recurrence.

Anyone who suspects he may have Dupuytren’s shouldn’t wait until his finger is curled over before seeing a doctor.

Harlow welcomes new executive director

Gretchen Marion

HALLOWELL — The Harlow, home of the Kennebec Valley Art Association, is welcoming Gretchen Marion as its new executive director.

Marion has more than 20 years of experience in management, marketing, fundraising and finance. She is former executive director of the Submarine Force Library and Museum Association, in Groton, Conn., a nonprofit educational foundation that provides marketing, fundraising, exhibit and education services to the USS Nautilus Museum.

“I’m excited to embark on this new journey and to meet fellow artists! It has long been a dream of mine to work in a gallery, and The Harlow is beyond what I could have imagined,” Marion said. “I’m looking forward to blending my business experience with my life in the arts. Also excited to become part of the community in Hallowell.”

Susan Macpherson, president of the Harlow/ KVAA board of directors said, “We are thrilled to welcome Gretchen Marion to the Harlow/KVAA. Her professional experience will help us continue the growth we’re experiencing in our new location. She is a strong addition to both Hallowell and the Kennebec Valley art community. I look forward to the creativity and leadership she will provide The Harlow.”

Marion succeeds Deb Fahy, who served the organization for more than 14 years.

The Harlow is a membership based 501(c)3 nonprofit dedicated to connecting and celebrating art, artists and community in Hallowell since 1963. Hours are noon to 6 p.m. Wednesday through Saturda. For more information, visit harlowgallery.org or call 207-622-3813.

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