New Treatment Brings Relief for Debilitating Hand Condition

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Dr. Stuart Elkowitz Explains New Options for Dupuytren's Disease

Millions of Americans suffer from Dupuytren's disease, a benign condition that can cause progressive and sometimes crippling deformities of the hand, making it difficult to type, shake hands, wear gloves, reach into a pocket or perform numerous other tasks. The afflicted have included Ronald Reagan, Margaret Thatcher, the playwright Samuel Beckett and the classical pianist Misha Dichter. “Until recently, surgery was the most effective treatment for people suffering from the most severe consequences of Dupuytren's,” says Dr. Stuart Elkowitz of Somers Orthopaedic Surgery & Sports Medicine Group. “But the recent introduction of an injectable drug that loosens the contracture of the fingers holds tremendous promise for many patients, eliminating the need for surgery and post-surgical physical therapy.”

Dupuytren's disease, a hand deformity that affects the connective tissue under the skin of the palm, usually develops slowly, over decades. It typically starts with a tiny nodule in the palm and may not initially cause significant inconvenience. As the disease progresses, knots of tissue form under the skin, eventually forming thick, rope-like cords that can pull one or more fingers into a bent position. Once this occurs, the affected fingers can't be relaxed or straightened completely and the condition is then known as “Dupuytren's contracture.” The pinky and ring finger are most commonly affected, often in both hands.
It has been 180 years since Baron Guillaume Dupuytren, a French military surgeon, described the disease and the surgery to correct it in 1831. Yet the root causes of Dupuytren's are still unknown. While it can occur in persons of both genders, any ethnic background, and at any age, the condition is more common in men of Northern European descent over the age of 50. A family history of the condition increases risk as does diabetes. Smoking and alcohol use are also associated with higher risk.

Dupuytren's disease cannot be cured but it can be treated to slow the progression of the condition and improve hand function. Treatment involves removing or breaking apart the cords that pull the fingers in toward the palm. This can be done in several different ways depending on the severity of the symptoms and other health considerations. Surgical options include fasciotomy, which cuts or breaks up the cords to release the tension that constricts the fingers, and fasciectomy, a more invasive procedure in which the abnormal tissue is removed through incisions in the palm and affected fingers. The duration of the recovery period and the amount of physical therapy required after surgery depend on the procedure used.

“The introduction of an injectable drug that can eliminate the need for surgery for many patients is an important advance,” says Dr. Elkowitz. “The drug is an enzyme, called collagenase, that breaks down the buildup of excessive collagen in the knots and cords that characterize Dupuytren's contracture. The injection softens and weakens the collagen and we follow up the next day manipulating the finger to release the cords and straighten the fingers.”

The drug (brand name: Xiaflex®) was approved by the FDA in February 2010 and by the European Union in February 2011. It contains a combination of 2 collagen enzymes that have been isolated and purified from the fermentation of Clostridium histolyticum bacteria. When injected directly into a Dupuytren’s cord, these 2 types of collagenase work synergistically to enzymatically disrupt the collagen.

“We're pleased to be able to offer a reliable and effective alternative to surgery to our patients,” Dr. Elkowitz concludes. “Results to date have been impressive and patients who have experienced both surgery and the collagenase injection appreciate the less invasive procedure.”

Xiaflex® is a registered trademark of Auxilium Pharmaceuticals, Inc.

Somers Orthopaedic Surgery and Sports Medicine Group, founded in 1988, is one of the most comprehensive and specialized practices in the region. Highly trained physicians specialize in diagnosing and treating all orthopaedic, rheumatological, and pain management problems in adults and children. All surgeons are board certified and experienced, having completed rigorous training at the finest medical institutions in the country. The staff includes fifteen physicians, five physicians' assistants, three physical therapists and a supporting staff of over 100. The group's physicians perform all types of arthroscopic surgery, ACL reconstruction, minimally invasive joint replacement, computer navigation, revision joint replacement, sports care, spine surgery, fracture care, hand, ankle, and foot surgery. State-of-the-art facilities include digital radiology, MRI and ultrasound. http://www.somersortho.com

Stuart J. Elkowitz, M.D., F.A.A.O.S., C.A.Q.H.S. is board certified in orthopaedic surgery and received a Certificate of Added Qualification in Hand Surgery (C.A.Q.H.S.), which is the equivalent of board certification in hand surgery. He is a member of the American Society for Surgery of the Hand, the American Academy of Orthopaedic Surgeons and the New York State Orthopaedic and Westchester County Medical Societies. Dr. Elkowitz obtained his medical degree from New York University School of Medicine and graduated cum laude with a B.S. degree in economics from the Wharton School in Pennsylvania. He completed his orthopaedic surgery residency at the Hospital for Joint Diseases and did a clinical rotation at the Shock Trauma Center in Baltimore MD. Specializing in hand surgery, Dr. Elkowitz completed a fellowship at the Raymond Curtis National Hand Center at Union Memorial Hospital in Baltimore. He is the co-author of several publications involving orthopaedic problems of the hand, wrist and fingers and has had research presented at a number of prestigious meetings.

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MELISSA CHEFEC
MCPR
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