Name of the Procedure:

Manipulation, palmar fascial cord (ie, Dupuytren's cord), post enzyme injection (eg, collagenase), single cord

Summary

This procedure involves manually manipulating the thickened and shortened cords in the palm that result from Dupuytren's contracture after an enzyme (such as collagenase) has been injected to weaken the cord. The goal is to improve hand function by breaking the cord.

Purpose

The procedure addresses Dupuytren's contracture, a condition where the fingers become permanently bent in a flexed position due to the thickening of the palmar fascia. The goal is to restore finger extension and improve overall hand function.

Indications

• Presence of a palpable and functionally limiting cord in the palm
• Patients experiencing difficulties with everyday activities due to finger contracture
• Suitable for patients who have a single, well-defined Dupuytren’s cord that has responded to enzyme injections.

Preparation

• Pre-procedure assessment including physical examination
• Discussion of medical history and any medications being taken
• No specific fasting required, but follow any instructions given by the healthcare provider
• Review of the enzyme injection process and verification that it has been adequately administered prior to manipulation.

Procedure Description

1. The patient is seated comfortably with the affected hand positioned for easy access.
2. Local anesthesia may be administered to the area to minimize discomfort.
3. The physician manually stretches and manipulates the affected finger(s) to break the weakened palmar fascial cord.
4. The manipulation is done carefully to avoid skin tears and other injuries.
5. The hand may be splinted after the procedure to maintain the gained extension.

Duration

Typically, the procedure takes about 15 to 30 minutes.

Setting

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

Personnel

• Physician (often a hand surgeon or specialist)
• Medical assistant or nurse

Risks and Complications

• Bruising or swelling
• Skin tearing
• Pain or discomfort
• Incomplete correction of the contracture
• Recurrence of the contracture

Benefits

• Improved finger extension
• Enhanced hand function
• Relief from the limitations of Dupuytren's contracture
• Benefits are typically realized immediately after the procedure, though full function may improve over several weeks.

Recovery

• Post-procedure care may include splinting the hand.
• Avoid strenuous activities with the affected hand for a few days.
• Follow-up appointments for monitoring progress and addressing any complications
• Patients are often advised to perform specific hand exercises to maintain range of motion.

Alternatives

• Surgery (fasciotomy or fasciectomy)
• Needle aponeurotomy
• Radiation therapy
• Each alternative has its own pros and cons and is chosen based on the severity of the condition and patient preference.

Patient Experience

Patients may feel pressure or mild discomfort during the manipulation. Post-procedure pain is managed with over-the-counter pain relievers, if necessary. Hand function and range of motion typically improve rapidly after the procedure, though mild swelling or bruising may occur.