When the unthinkable happened and Elizabeth Carr of Leeds fell and broke her wrist, it temporarily put a stop to her active lifestyle that included golfing and strength training.
While she underwent surgery to her wrist to install a stabilizing plate, her doctor recommended that soon after she return to playing golf. She did, then, just about a year later, she felt a bump inside the palm of the same hand.
After visiting with her primary care provider, Carr, 62, learned she had a condition called Dupuytren’s contracture.
A debilitating condition
Dupuytren’s contracture affects about 5% of Americans who can’t completely straighten some of their fingers, complicating everyday activities such as writing, throwing a baseball, golfing, or even preparing your own meal.
The disease is a condition in which thickened, scar-like tissue forces several fingers to flex forward, caused by the development of a fibrous connection between the finger tendons and the skin of the palm. It mainly affects the ring and pink finger, but can affect the thumb and middle finger. Dupuytren’s contracture often first occurs in only one hand, affecting the right hand twice as often as the left. About 80% of affected individuals eventually develop features of the condition in both hands.
“My doctor left it up to me to decide what course of action to take. So, I began to do my research to learn more about the disease and its treatments, of which surgery is just one of the options today. I didn’t want surgery again and saw that radiation was being used on some people to stop the disease’s progression, so I decided to explore that option,” said Carr.
A visit to Baystate Medical Center
Her doctor referred her to Dr. Michael Yunes, chief of Radiation Oncology at Baystate Medical Center.
“When patients come to me for treatment, they have often done their own research like Elizabeth did and have firsthand knowledge of the procedure. Most, but not all of them, have been able to avoid any surgery. Several of these patients have already failed surgery and wanted to prevent any further deformity,” said Dr. Yunes.
“I have treated over a dozen patients for Dupuytren’s contracture. The process is easy and we now use a 3D printer in conjunction with our advanced planning system to make the setup as accurate and quick as possible,” he added.
How radiation helps
Low dose radiation therapy for Dupuytren’s contracture, more often performed in Europe than America, works by reducing the inflammation and growth component of the process. The goal is to prevent the cording and restriction that occurs in the hand. It is important to understand that not all cases need treatment. A large percentage of patients will have spontaneous resolution of their nodules. However, once cords form they often persist. There is not a great deal of data evaluating different treatment options with only a couple of trials comparing radiation to the natural history of the disease. No treatment is without side effects, so it is important to always understand the potential risks and benefits,” noted Dr. Yunes.
The best results occur when the treatment is performed early in the course of the disease both in terms of length of time present and the amount of deformity. With early treatment, up to 85% of patients treated have stability or reduction in the cords or nodules. In terms of side effects, approximately 50% of patients have mild to moderate reactions, mostly redness or peeling of the palms. This usually does not require treatment and resolves on its own.
“At Baystate, we believe in offering radiation for patients with Dupuytren’s contracture after they have evaluated all available options. We use a CT scan to determine the true depth of the cords and nodules and we create a three-dimensional ‘glove’ with varying thicknesses to precisely and accurately deliver radiation to these structures, while avoiding as much radiation as possible to the joints and skin folds. This limits the side effects as much as possible,” said Dr. Yunes.
A good bedside manner
Carr noted that Dr. Yunes has “a very calming manner.”
“I felt very comfortable. He told me that I was a good candidate since I was only in the beginning stages of the disease and my fingers weren’t at the point of bending, which is important for the radiation to be effective. After talking with him, I felt that radiation was a good route for me, especially since I’m such an active person. And, Dr. Yunes told me that I could continue to golf and use my hand during my treatment,” said Carr.
“Once I started radiation, the staff there were just wonderful and unbelievably great in making me feel very comfortable,” she added about treatment which was daily for 5 days followed by a 6-8 week break, then another 5 treatments.
Recommendations for other common treatments for Dupuytren’s contracture vary due to the severity of the disease and include steroid shots, enzyme injections, and needle aponeurotomy. Surgery is often used in more advanced cases where patients have limited mobility of their hand, the problem is that eventually the scar tissue and contractures may recur resulting in even more limited mobility. Radiation can be used after surgery, but it is less successful.
Even children are susceptible
More common in men, Dupuytren’s contracture most often occurs after age 50. For women, it tends to appear later and is less severe. However, Dupuytren’s contracture can occur at any time of life, including childhood.
Believed to have a genetic component and to run in families, other risk factors for developing Dupuytren’s contracture may include smoking, excess alcohol use, liver disease, diabetes, high cholesterol, thyroid problems, certain medications such as those used to treat epilepsy, and previous injury to the hand.
“I would highly recommend considering this procedure for those with Dupuytren’s contracture. It was one of the easiest procedures that I have undergone with little discomfort. And, the best part of all was that I was able to continue with all my activities,” said Carr.
To make an appointment
To learn more about how radiation therapy for Dupuytren’s contracture could benefit you, and to make an appointment with Dr. Yunes, call 413-794-9338.