Treatment of Dupuytren's Disease: Collagenase Clostridium Histolyticum

Authors

Thomas Vincent Gocke III, University of LynchburgFollow

Specialty

Orthopaedic Surgery

Advisor

Thomas Colletti, DHSc, PA-C, DFAAPA

Abstract

Dupuytren disease is predominantly a fibroproliferative disease when activated promotes inflammatory fibrosis that affects the hand/fingers and results in contracture deformities. ^1,2These cord-like structures most commonly affect the ulnar-sided fingers (Ring finger most commonly), occasionally involve the radial fingers and leads to flexion deformities at the Metacarpal Phalangeal (MCP) and Proximal Interphalangeal Joints (PIP).³This condition is more commonly seen in descendants of Northern European/Scandinavian heritage. Males are affected in a 2:1 ratio compared to women, with the disease also affecting men more severely. ^3,4 If presenting with contractures and limited motion at an early age, this is often considered to be an indication of a more long-term form of Dupuytren’s disease.^8-16 Indications for collagenase Clostridium Histolyticum (CCH) injection treatment are based on the effects of disease on the patient's quality of life and flexion contractures > 20°.^{3, 5,6,8-16} Patients with a positive “Hueston tabletop test”,¹²MCP contracture of 30°, or PIP contracture of 15-20°will elect to have treatment. Collagenase Clostridium Histolyticum (CCH) injection and manual finger manipulation have proven to be one of the more effective nonsurgical therapies in the treatment of Dupuytren’s contractures. ^8-29The use of CCH has resulted in an improved duration of functional improvement and prolonged the recurrence of symptoms. ^8-11,16-32

Recommended Citation

Gocke TV. Treatment of Dupuytren's Disease: Collagenase Clostridium Histolyticum. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2019; 1(3).