Knots could signify condition
Have you noticed a knot in your palm? You can’t really remember when it appeared, and don’t remember doing anything that would have caused it. It doesn’t hurt, and your other palm doesn’t have a knot like this. What is it? Should you be worried? Is it going to get worse? Maybe you have noticed that there appears to be a long cord coming from the knot and extending toward the wrist or finger.
Chances are, you have a condition called Dupuytren’s disease, named for Baron Guillaume Dupuytren, who first described the surgical procedure for it in 1831.
Dupuytren’s disease is a hereditary condition which affects the tissue in the palm just beneath the skin. The effect can range from small knots or pits in the skin to tight cords of fibrous tissue that pull the fingers into the palm.
Although most cases start in middle age and affect those of northern European descent, the condition can affect people of all ages and ethnicities. Some patients may not believe anyone in their family has ever had this issue until they question them further and discover several of them have knots in the palm that have never caused them any problem. Patients often believe the knots are related to arthritis, cysts or tumors and are relieved to find out they are not cancer and that oftentimes no treatment is required.
A common test doctors will perform is called the tabletop test. The patient is asked to place their hand flat on a table, and if they are able to do so, then no treatment is needed. If the hand cannot lie flat, then contracture is present, and treatment may be required. Your doctor can determine whether or not intervention is needed, and if so, there are several options.
Treatment Options
Surgical excision has been the most common treatment for Dupuytren’s contracture and involves opening the palm and removing all affected tissue. Recovery can be prolonged with weeks of wound healing and months of therapy and splinting to help regain motion and reduce swelling. Patients who are affected by Dupuytren’s disease are much more likely to make scar tissue after surgery, and splinting is needed for several months afterward to reduce recurrence of the contracture.
Needle Aponeurotomy is not widely available and consists of dividing the cord by using a hypodermic needle as a small knife. This is done in the office under local anesthesia, and can improve the ability to straighten the finger, but does not remove the abnormal tissue. This procedure is useful in patients who for medical reasons are not able to undergo surgery.
Most recently, there is an injectable medication available that dissolves the cord. Xiaflex is made by Auxilium, and contains collagenase, an enzyme which dissolves collagen, the main component in the Dupuytren’s cord. This newest alternative to surgical excision allows the patient to resume normal activities much more quickly. The material is injected into the cord one day, then a day or so later the hand is anesthetized and the finger pulled straight to rupture the softened cord. The patient wears a splint for several hours daily, usually at night, to stretch the skin and prevent the contracture from recurring. Splinting continues for several months after treatment.
Xiaflex is approved by most insurance companies and is a popular alternative to traditional surgery. It is performed only by physicians who are specially trained in its proper use. You may visit www. auxilium.com for a qualified provider near you.
For patients with Dupuytren’s disease without finger contracture, neither surgery nor injection is necessary, but trauma can be a source of irritation to the palmar tissue and can make it worse. If you perform activities that may irritate your hands (e.g., using power tools), the simple use of padded weight-lifting gloves can help protect your palms from this source of irritation.
If you suspect you may have Dupuytren’s contracture or you have any other concerns about your hands, contact the Center for Hand Surgery for a consultation.
Dr. Michelle Ritter, whose practice is the Center for Hand Surgery, has the most extensive experience in arthroscopic wrist procedures in the tri-state area.
