Dupuytren's Disease: Pioneering new treatments for a crippling condition

Doctors are motivated by subjects that most people don't even know exist. Unless you're among the 3%-6% who suffer from Dupuytren's Disease, there's a good chance you've never heard of this condition, or of a new therapy recently approved by the FDA.

Dupuytren's Disease is a condition almost entirely restricted to people of Northern European descent and is most common in patients over the age of 60. The condition affects the fascial layer of the palm, between the skin and the tendons. The fascia thickens and develops first nodes, and eventually long strands of fiber that extend into the fingers. The fingers are forced to clench inward toward the palm, starting with the small and ring fingers and oftentimes affecting the entire hand, including the thumb.

Because Dupuytrens disease does not respond to therapy and is almost always progressive, the most common treatment has been surgical. During this surgery, the thickened tissue is removed from the palm, and the fingers are extended. The success of this method has allowed many to recover much of the hand motion that they had lost because of the disease. The technique, however, presents the challenges and risks inherent in any extensive hand surgery. Alternative treatment modalities have been the focus of research over the last 20 years and a new method of treating Dupuytrens was approved in Europe almost 10 years ago.

Collagenase is an enzyme, that eats away the tissue that causes Dupuytrens disease. This medication is injected into the Dupuytrens tissue, and the fingers are extended, without surgery on the following day. Dupuytren's has been treated with collagenase in Europe for over 10 years and the outcomes have been as good, or better, than surgical management without many of the complications. Furthermore, the recovery after collagenase injections is significantly easier, than after surgery. Oftentimes patients are able to return to relatively normal activity after only two weeks. Collagenase has been recently approved for use in the United States, by the FDA, after extensive efficacy and safety studies in Europe.

As a doctor specializing in hand and upper extremity injury, the ability to offer a new and less invasive treatment for Dupuytren's is amazing. I am continually focused upon providing options for the treatment of upper extremity disorders and I feel that the addition of collagenase to my arsenal is an important advancement.

Dr. Erik Dorf, a Colorado native raised in Eagle County, joined Vail-Summit Orthopedics in 2008. A true world citizen, Dr. Dorf has traveled widely, teaching skiing in France and Austria. As Founder and Director of Building With Books, he directed on-site schoolhouse construction and coordinated community development for the construction of three schools in Brazil, Malawi Africa and Nepal. His recent work on a study of post-injury hand therapies has been featured in the September 2010 issue of The Journal of the American Academy of Orthopedists. Those interested in the study may refer to the Medical News Today article at: http://www.medicalnewstoday.com/articles/196788.php.