April 21, 2017 | Using our hands to grasp a tool or offer a round of applause are simple tasks made possible by the presence of a tissue just beneath the skin called palmar fascia.
“It has a real function,” said Theresa Wyrick, M.D., associate professor of orthopaedic surgery in the UAMS College of Medicine. “It helps stabilize the skin under the palm so that you can hold things.”
Wyrick demonstrates on her own palm that the skin there is not as mobile as it is on the other side of her hand. The palmar fascia keeps the skin in the palm stable, Wyrick said.
“It’s really a beautiful design that allows us to grab things, hold tools and use the hand so that the skin is stable. It has the same function on the soles of the feet to help us walk and move around,” she said.
What happens in some people is that the palmar fascia turns into lumps, cords and nodules. That progression over time pulls the fingers into the palm, making a person unable to open his or her hands. It’s a benign condition known as Dupuytren’s contracture, named for the doctor who first described it.
Shawn Wilson of Cabot first noticed his fingers wouldn’t completely straighten about two years ago. He had been in a traffic accident March 2013. Several months following the accident, Wilson had been on medications, many of which made him drowsy.
“There were times I would sleep up to 20 hours a day,” Wilson said. “Much of 2013 and 2014 was a fog. But when I came out of that fog I really noticed how bad my hands were. My wife and daughter told me I had talked about my hands, but there’s not much I remember during that time.”
Once Wilson came off the medication, he was fully aware of how limited his hands were. He talked to his primary care physician in Cabot.
“He told me I hand Dupuytren’s contracture. I started researching online and found several specialists at Johns Hopkins in Baltimore. I fully expected I was going to have to have surgery.”
Wilson and his family flew to Maryland for an appointment. The doctor said there was medication that would help his condition without surgery. Xiaflex received FDA approval in 2010 for the treatment of Dupuytren’s contracture.
“He told me I could go back to Arkansas for that.”
Wilson went back to the Web and found Wyrick’s name as a physician who administers the drug.
“I saw different websites that rate doctors. Dr. Wyrick had the highest rating of any of the doctors who administered it. I called and made an appointment with her,” Wilson said.
Doctors can only administer two injections at a time every 30 days. In January 2017, Wilson had two injections in his left hand. He came back a month later for his third injection. By the end of March, Wyrick will begin injections on his right hand. Wilson says he’s pleased with the results so far.
“The previous treatment we had was pretty invasive,” Wyrick said. “We did a large surgery with lots of incisions throughout the finger extending into the palm, taking out all the palmar fascia involved in the condition.”
Wyrick said the time it took to recover from a surgery like that was extensive and included lots of therapy, lots of splinting and delayed wound healing. Many times it would take patients up to six weeks to get back to activities and they’d have to wear a splint all the time.
Wyrick says the injections have revolutionized the way doctors treat the condition. “We’ve almost completely moved away from the surgical treatment for Dupuytren’s contracture,” she said.
The injection only takes a few minutes and is done in office with no incisions, anesthesia or extended course of therapy.
“It’s basically an enzyme,” Wyrick said. “We place it into the thickened area of the palmar fascia. The enzyme breaks down the knotted area or cord over the course of several days.”
A few days after his injection in March, Wilson returned to have his bandages removed. Wyrick numbed the area and stretched the finger out by popping the cord that had been weakened by the drug.
Wilson has to wear a splint after his finger has been straightened, but only at night, for four weeks.
“Most patients are able to get back to their activities within 10 days,” Wyrick said. “That is a big difference from recovering from the surgery, which took several weeks.”
“Dr. Wyrick has been great. She explained everything and took her time with me. I understand why she has such a high rating.”
Dupuytren’s contracture is most common in men of Viking or Scandinavian descent over the age of 40 and affects about 5 percent of the population.