20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren's contracture)

Name of the Procedure:

Injection, enzyme (e.g., collagenase), palmar fascial cord (i.e., Dupuytren's contracture)

Summary

This procedure involves injecting a specialized enzyme into the thickened bands of tissue in the hand affected by Dupuytren's contracture to help dissolve the excess collagen and restore finger movement.

Purpose

The procedure treats Dupuytren's contracture, a condition where the connective tissue in the palm thickens and tightens over time, causing the fingers to bend inward. The main goal is to break down the collagen buildup, improving hand functionality and alleviating discomfort.

Indications

• Presence of a visible and palpable palmar fascial cord
• Difficulty in straightening fingers
• Decreased hand function affecting daily activities
• Patients who meet specific medical criteria and have not responded to other treatments

Preparation

• No specific fasting required
• Patients may need to adjust medications based on physician guidance
• Pre-procedure evaluation, including physical examination and imaging studies, might be necessary to assess the severity

Procedure Description

1. The patient’s hand is sterilized and numbed with local anesthesia.
2. A small needle is used to inject collagenase directly into the palmar fascial cord.
3. The enzyme breaks down the excess collagen over 24-72 hours.
4. A follow-up appointment is scheduled, often the next day, where the doctor manually manipulates the finger to break the remaining cord, if needed.

Tools/Equipment:

• Syringe and sterile needle
• Collagenase injection

Anesthesia:

• Local anesthesia for injection site

Duration

The initial injection takes about 15-20 minutes. Follow-up manipulation, if necessary, may take an additional 15-30 minutes.

Setting

The procedure is usually performed in an outpatient clinic or a physician’s office.

Personnel

• Physician (e.g., an orthopedic surgeon or hand specialist)
• Nurse or medical assistant

Risks and Complications

Common Risks:

• Pain or discomfort at the injection site
• Swelling or bruising
• Mild allergic reactions

Rare Complications:

• Tendon damage or rupture
• Infection
• Severe allergic reactions

Benefits

• Improved hand function and finger mobility
• Non-surgical, minimally invasive option
• Quick recovery time compared to surgical alternatives

Recovery

• Keep the hand elevated and limit movement for about 24 hours
• Follow-up manipulation may be required the next day
• Wear a splint if advised by the doctor
• Follow-up appointments to monitor progress

Alternatives

• Surgical fasciectomy: involves removal of the affected tissue; longer recovery
• Needle aponeurotomy: a needle is used to break the cord mechanically; less invasive but may have higher recurrence
• Physical therapy and splints, though less effective for severe cases

Patient Experience

Patients may feel mild discomfort during the injection and manipulation. Post-procedure soreness and bruising are common but manageable with over-the-counter pain medications. Most patients experience significant improvement within a few weeks.