التعريف والنظرة العامة
The palmar fascial cord is a type of connective tissue in the palm of the hand. If the cord is affected by a disorder, such as Dupuytren’s contracture, it thickens and causes the palm of the hand and one or more fingers to contract. The exact cause/s of the disorder is yet to be identified, but treatments are available for the condition. Dupuytren’s contracture is a disease that develops over a long period. It is characterised by the palm and fingers of the hand being slowly drawn inward. This is a direct result of the thickening connective tissue in the palm. Other symptoms of the disease differ from person to person. For example, it can be a painful condition to some people, while others may not even know they are affected, aside from noticing the visible symptoms of the condition. Doctors do not require complex tests to diagnose the condition. A simple physical examination of the hand and evaluating if the patient can place his or her hand flat on the table should be enough to diagnose Dupuytren’s contracture. The disease may develop over a long period of time, but it does so in stages. In the first stage, pain or discomfort can be felt in the palm and/or small and ring fingers of the hand. This stage is referred to as the proliferative phase. As the disease progresses into the involutional phase, the palmar fascial cord begins to tighten and becomes a bit noticeable. In the final stage, called the residual phase, the cord contracts resulting in the palm forming like a cupped hand. In this stage, the patient will find it difficult, if not impossible, to lay the hand flat on a table. Dupuytren’s contracture can be treated using a variety of methods. One method is to puncture the cord using a needle to release the contracture. The cord may contract again in the future, but the procedure can be repeated as needed. Another method is to perform surgery to remove the cord and tissue affected by the condition. The results are long lasting, but therapy is usually required after the procedure. One method that is gaining popularity is injecting the affected area with a collagenase enzyme called Clostridium histolyticum. The enzyme weakens the cord to a point where the doctor can break it and straighten the hand and finger/s.
من يجب أن يخضع للنتائج المتوقعة
As mentioned earlier, the Dupuytren’s contracture may or may not cause pain. However, there will be clear signs of the condition. Patients who notice a visible deformation of their hand and/or finger without any obvious cause should consult their doctors. The doctor will then present various treatment options and recommend a particular method. If the patient does not wish to undergo surgery for whatever reason, the injection of the collagenase enzyme might be the best option. The enzyme will then slowly break down the thickened connective tissue, softening it in the process. As a result, the doctor should be able to break the tissue and return the finger to its normal condition. However, the results may not be permanent. Should the cord tighten again, the procedure will need to be repeated.
كيف يعمل هذا الإجراء؟
Prior to the procedure, the doctor must first diagnose the condition as Dupuytren’s contracture. The only test that is usually required for diagnosis is a physical examination of the hand. The doctor may also request information on the patient’s current medical condition, medical history, when the symptoms were first noticed, and if the condition is accompanied by other symptoms, such as pain. A couple of decades ago, surgical intervention was usually the recommended method for treatment. However, the development of the collagenase enzyme led to a less invasive procedure. If the patient agrees to the injection, the enzyme will be injected to the palm of the hand, precisely at the affected area. The enzyme is not injected into the fingers because of the damage it can cause. After the first injection, the patient should be able to notice an improvement. The procedure may be repeated after a certain period for improved results.
المخاطر والمضاعفات المحتملة
Any medical procedure has associated risks and possibility of complications. In this procedure, adverse effects are common, but do not result in long-term damage or discomfort to the patient.
Such adverse effects include pain, bleeding, and discomfort at the injection site. It is also possible for the patient to develop complications that are more serious, such as a ruptured tendon and a condition called complex regional pain syndrome. But serious complications rarely occur.
Although injecting collagenase enzyme to treat the condition is considered highly effective, the results are not immediate. It may take some time for significant results to occur. During this time, the patient will need to avoid injuries to the hand.
Patients should also be aware that the results might not be permanent. In time, the condition may reoccur or may even seem to worsen. When this happens, the procedure may be repeated or the doctor may recommend another treatment option, such as surgery.
- Hindocha S, McGrouther DA, Bayat A. Epidemiological evaluation of Dupuytren’s disease incidence and prevalence rates in relation to etiology. Hand (N Y). 2009 Sep. 4(3):256-69. [Medline]. [Full Text].
- Meathrel KE, Thoma A. Abductor digiti minimi involvement in Dupuytren’s contracture of the small finger. J Hand Surg Am. 2004 May. 29(3):510-3.
**What is Injection of Enzyme for Palmar Fascial Cord: Overview, Benefits, and Expected Results**
**Q: What is an Enzyme Injection for Palmar Fascial Cord?**
**A:** An enzyme injection for palmar fascial cord is an innovative treatment for chronic pain and inflammation caused by the palmar fascial cord, a thick band of connective tissue that runs along the palm side of the hand. The injection involves using an enzyme called collagenase to break down and dissolve the taut and thickened cord, thereby reducing pain and improving flexibility.
**Q: Who is a Candidate for the Treatment?**
**A:** Patients who suffer from chronic pain, stiffness, and tenderness in the palm or fingers caused by a tightened palmar fascial cord are potential candidates for this treatment. It is often considered when conservative measures like rest, physical therapy, and pain medication have not provided significant relief.
**Q: How is the Procedure Performed?**
**A:** The procedure is performed in an outpatient setting. The area around the palmar fascia is numbed using local anesthesia. Under ultrasound guidance, the doctor injects collagenase directly into the cord. The injection typically takes only a few minutes.
**Q: What are the Benefits of Enzyme Injection for Palmar Fascial Cord?**
**A:** Potential benefits of the treatment include:
* **Pain Reduction:** The enzyme breaks down the taut cord, alleviating pain and discomfort.
* **Improved Flexibility:** Breaking down the fibrotic cord improves hand mobility and range of motion.
* **Non-Surgical Treatment:** This treatment offers an alternative to invasive surgery, reducing recovery time and potential complications.
**Q: What are the Expected Results?**
**A:** Most patients experience a gradual reduction in pain and improvement in hand function within several weeks after the injection. However, results can vary among individuals, and some may require a second injection for optimal outcomes.
**Q: What are the Potential Risks or Side Effects?**
**A:** Minor side effects may include temporary discomfort, swelling, or bruising at the injection site. Rarely, allergic reactions or nerve damage can occur. Thorough consultation with your doctor will address any potential risks.
**Q: How Long Does the Improvement Last?**
**A:** The effects of the injection can last for several months to years. However, the long-term effectiveness may vary depending on the patient’s individual condition and activities. Additional follow-up injections may be necessary if symptoms return.
Enzyme injection for palmar fascial cord is a promising treatment option for patients struggling with chronic pain and stiffness caused by a tightened palmar fascial cord. It offers significant benefits, including pain reduction, improved flexibility, and a non-surgical approach. By understanding the procedure, potential risks, and expected results, patients can make an informed decision with their healthcare provider about whether this treatment is right for them.