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Top of Utahns seek help for palm-related woes - Ogden Clinic provided source, Standard-Examiner 09/29/2013

(Standard-Examiner) OGDEN — Doctors are treating more and more patients with a little-known disease that causes an abnormal thickening beneath the skin in the palm of the hand.

The incidence of the disease is about three in 10,000, said Ogden Clinic orthopedic surgeon Dr. Kevin Stucki.

Although he does not believe the disorder is on the rise, he is seeing and treating more patients with it because he believes they are more educated about the illness and there are more attractive treatment options available.

The disease is characterized by thickening that occurs in the palm and can extend into the fingers. Firm cords and lumps may develop that can cause the fingers to bend into the palm, causing Dupuytren’s contracture. Stucki said.

“Although the skin may become involved in the process, the deeper structures such as the tendons are not directly involved,” he said.

Occasionally, the disease will cause thickening on top of the finger knuckles, or nodules or cords within the soles of the feet.”

Dr. Jon Donigan, an orthopedic surgeon at Tanner Clinic in Layton, said risk factors include family history, being male and having Northern European background, diabetes, alcoholism, epilepsy, smoking disorders and possibly repetitive hand trauma.

Mabel Woods said she started showing signs of the disease when she was 50 years old. The 70-year-old Ogden resident said she has it in both hands.

Woods said the disease runs in her family. Both her father and brother also suffer.

“My brother had surgery and I watched how painful the surgery and physical therapy was for him and the surgery did not correct his contracture,” she said.

“I made up my mind I wasn’t going to have surgery and lived with Dupuytren’s for 20 years.”

While the disease isn’t painful, Woods said she has trouble opening jars.

“It is just ugly to have your hands curled up,” she said.

Woods recently changed her mind, however, and Stucki treated her with an injection. The procedure took less than 30 minutes. The next day her hand was flat and she was able to use it.

“It was vastly different from the casts on the hands and month-long recovery my brother had experienced with surgery,” she said.

Stucki and Donigan said the first way to treat the disease is to observe it. Intervention is a last result when there is pain or functional impairment.

With initial diagnosis, Donigan said, some physicians will give a cortisone injection to help with the pain. This does not change the natural history or progression, but can help with the symptoms.

Stucki said the most exciting development in treatment is a medication that can be injected that essentially melts the cords and allows improved function without surgery.