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The "Viking's Disease"
Today we're sitting with Dr. Brian Janz to find out what the heck Dupuytren's contracture is, why it's sometimes called the Viking's Disease, who tends to suffer from it, a brief history; and what can be done for it, and how it can be done.
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Learn more about Dr. Brian Janz
Brian Janz, M.D
Dr. Brian Janz is a board-certified, fellowship-trained hand and upper extremity surgeon.Learn more about Dr. Brian Janz
Transcription:
The "Viking's Disease"
Joey Wahler (Host): It's the hand condition named for a French surgeon that can cause debilitating hand pain. So we're discussing Dupuytren's Contracture. This is a Bone to Fix, a podcast from the setters for advanced orthopedics. Hi, I'm Joey Wahler and I've got a bone to fix with you. Thanks for listening. Welcome to our series called Hands On. Focusing on different parts of the hand from fingertip to wrist. Today, we're talking fingers, our guest, Dr. Brian Janz, a hand and upper extremity surgeon with Orthopedic Associates of Central Maryland Division. Dr. Janz, thanks for joining us.
Brian Janz, MD: Thanks for having me today.
Joey Wahler (Host): So first, what is Dupuytren's contracture? Sounds like a mouthfull.
Brian Janz, MD: Yeah, no, it definitely is a difficult word to say sometimes now dupuytren's contracture is a condition that we see in the hands that progresses over time. Usually we see it popping often individuals, around the age of 40 and 50 years of age. And then as we age, it sort of develops a little bit more and progresses.
Usually we see small little nodules in the Palm of the hand and as the disease progresses, there's cords that form that are almost thickening in the Palm that then lead to contractures of the fingers. And sometimes those contractures can get fairly debilitating because the finger gets really stuck down in a flex position and opening the hand is almost impossible.
Joey Wahler (Host): And so to be a little more specific, what exactly is going on in the hand inside that's causing this?
Brian Janz, MD: So it's a Palmer fibrosis. So underneath the skin, there's a layer of thicken tissue, that over time thickens very specifically. And you can almost think of it in three stages. So the first stage in the Palm of the hand, you're going to feel this thickened tissue. That's almost like a callous. It can be painful sometimes. It can be non painful.
Sometimes patients will come in thinking they have a tumor or a cancer. But it's usually very specificly located in the distal aspect of the hand almost by the Palmer crease or just a little bit distal of that. And it stays as a nodule. It could be for a long time. As it progresses almost into stage two where a cord forms, and that's gonna be a thickened line that runs along the Palm of the hand.
Sometimes from the fingers all the way down to, almost to the base of the wrist. And it can be fairly thick, sometimes painful also. And that cord, then over time will contract causing your fingers to flex and not extend.
Joey Wahler (Host): So, is this something, what you just described that we would see on the skin's surface?
Brian Janz, MD: Yeah, the nodules and also the cords you'll be able to feel they're fairly dense, and usually not painful.
Joey Wahler (Host): So what causes this Condition?
Brian Janz, MD: So it's kind of unknown. there are some risk factors that you can have. But most of the time it's, sporadic or sometimes, you can have a genetic predisposition for it.
Joey Wahler (Host): How about links between Dupuytren's contracture and things like smoking or alcohol?
Brian Janz, MD: Risk factors for dut trends, can definitely increase with use of tobacco and or alcohol. So there are some associations with higher incidents if you, do use a higher level of alcohol, or if you do partake in tobacco intake.
Joey Wahler (Host): And so simply put what's the link there?
Brian Janz, MD: It's unknown. I believe there is a thought that it could be related to microscopic changes due to blood vessel changes such as with smoking. It causes a vasoconstriction of the small vessels. So that may predispose you to, or progression of the dupuytren's disease.
Joey Wahler (Host): So in terms of symptoms, doctor, you mentioned the differences in the skin. And then there also changes to the fingers as a result, right?
Brian Janz, MD: Correct. Yeah. As the cord, thickens, the fingers are going to contract in your two joints, your MP and PIP joints, which are two very specific joints in the hand, will contract down where you'll have the inability to extend the finger.
Joey Wahler (Host): And the fingers also sometimes can kind of start to curl inward?
Brian Janz, MD: Yep. And then once you hit a more severe stage of the disease process, it can curl all the way in and almost have the fingers where they're touching the palms of the skins, which can be fairly debilitating.
Joey Wahler (Host): Now before we go any further, why is Dupuytren's contractures sometimes called the Vikings disease?
Brian Janz, MD: Now that's because from an ancestral standpoint, people of Northern European descent do have a higher risk for the disease. Now the disease is across pretty much all ancestors, but there is a higher predisposition in Northern Europeans descents.
Joey Wahler (Host): And how is Dupuytren's contracture usually treated?
Brian Janz, MD: So initially for the early on stages, we treat it conservatively. If you have a nodule or you have a cord where you're not contracting a joint, we usually leave it alone. And the reason we do that is because if we wind up manipulating the skin in the early processes, sometimes a scar tissue that forms is going to be worse than the actual dunpuytren's nodule or small cord that forms.
So unless there's a specific reason to go after it such as significant. Pain or other issues. We usually leave it alone in those stages. Once we get what's called a positive tabletop test, which means that the fingers are starting to contract or curl in where you can't extend it out, your fingers out. Then that's when we would then treat it either with injections of medications or with surgery.
Joey Wahler (Host): And speaking of surgery, what might that entail?
Brian Janz, MD: So actually one good option before we actually get the surgery are DiaFlex injections. So that is a newer treatment that we've been using in which it's non-surgical, where we will inject a medication. And several days later manipulate the cords. The vast majority Dupuytren's disease, even with fairly significant cords can be treated in nonsurgical fashion.
So definitely a huge step forward when it comes to, medical technology in treatment of this disease and then if that doesn't work or if you're not a candidate for it, then there are surgical options where we'll excise the dupuytren's disease, and, zigzag the skin in order to, treat the contractures.
Joey Wahler (Host): Now you alluded to it a bit, but to be sure if left untreated, how bad can this condition get?
Brian Janz, MD: It can get pretty bad with regard to the contractures, fingers can curl into the palms where it really causes a deformity and decreased function involving the hand. So when it comes to Dupuytren's disease, although we don't treat it aggressively during the early stages, it's pretty important to treat this in the middle stage before it gets too severe because the outcomes I think are much better.
Whether or not you're treating non-operatively with DiFlex injections or with the excision and adjacent tissue transfer. So being able to get in and see a hand surgeon and really have them evaluate it and hit that nice medium area of treatment, in order to maximize outcomes, I think is really important with this disease.
Joey Wahler (Host): Indeed. So let me ask you about that. If someone looks down at their hand and sees the changes, that have taken place, when do you know that it's time to see a doctor?
Brian Janz, MD: Anytime there's a concern involving the nodules or involving the cords, I think it's time to come in so we can start the discussions early about the different treatment options. If you have a trigger finger, which is sometimes associated with dues disease, where the finger's locking or popping then I think that's a great time to come in so we can evaluate it.
Because sometimes steroid injections can help with the trigger fingers, or we can look and see how bad the disease process is. And then of course, if you have a severe contracture, there's still options, but it may be a little bit more reconstruction associated with that. So yeah, if there's any concerns with Dupuytren's, I think coming in early is a great idea.
Joey Wahler (Host): Indeed a different use of the term trigger finger there, by the way as well. Let me ask you this because it's where I started and a great place to end. I think, to bring things full circle, this condition gets its name from a famous French surgeon, Geome Dupuytren who performed its first successful surgery way back in the 1830s. Right?
Brian Janz, MD: Absolutely.
Joey Wahler (Host): So a little history lesson there as well as valuable medical information as well doctor. Well folks we trust you're now more familiar with Dupuytren's contracture. Dr. Brian, Janz. Thanks so much.
Brian Janz, MD: Oh, thanks for having me today.
Joey Wahler (Host): And for more information or to make an appointment, please visit MDbonedocs.com. Again, that's MD B O N E D O C S.com. And that was a Bone That's Fixed. If you found this podcast helpful, please share it on your social media. Hoping your health is good health. I'm Joey Wahler.
The "Viking's Disease"
Joey Wahler (Host): It's the hand condition named for a French surgeon that can cause debilitating hand pain. So we're discussing Dupuytren's Contracture. This is a Bone to Fix, a podcast from the setters for advanced orthopedics. Hi, I'm Joey Wahler and I've got a bone to fix with you. Thanks for listening. Welcome to our series called Hands On. Focusing on different parts of the hand from fingertip to wrist. Today, we're talking fingers, our guest, Dr. Brian Janz, a hand and upper extremity surgeon with Orthopedic Associates of Central Maryland Division. Dr. Janz, thanks for joining us.
Brian Janz, MD: Thanks for having me today.
Joey Wahler (Host): So first, what is Dupuytren's contracture? Sounds like a mouthfull.
Brian Janz, MD: Yeah, no, it definitely is a difficult word to say sometimes now dupuytren's contracture is a condition that we see in the hands that progresses over time. Usually we see it popping often individuals, around the age of 40 and 50 years of age. And then as we age, it sort of develops a little bit more and progresses.
Usually we see small little nodules in the Palm of the hand and as the disease progresses, there's cords that form that are almost thickening in the Palm that then lead to contractures of the fingers. And sometimes those contractures can get fairly debilitating because the finger gets really stuck down in a flex position and opening the hand is almost impossible.
Joey Wahler (Host): And so to be a little more specific, what exactly is going on in the hand inside that's causing this?
Brian Janz, MD: So it's a Palmer fibrosis. So underneath the skin, there's a layer of thicken tissue, that over time thickens very specifically. And you can almost think of it in three stages. So the first stage in the Palm of the hand, you're going to feel this thickened tissue. That's almost like a callous. It can be painful sometimes. It can be non painful.
Sometimes patients will come in thinking they have a tumor or a cancer. But it's usually very specificly located in the distal aspect of the hand almost by the Palmer crease or just a little bit distal of that. And it stays as a nodule. It could be for a long time. As it progresses almost into stage two where a cord forms, and that's gonna be a thickened line that runs along the Palm of the hand.
Sometimes from the fingers all the way down to, almost to the base of the wrist. And it can be fairly thick, sometimes painful also. And that cord, then over time will contract causing your fingers to flex and not extend.
Joey Wahler (Host): So, is this something, what you just described that we would see on the skin's surface?
Brian Janz, MD: Yeah, the nodules and also the cords you'll be able to feel they're fairly dense, and usually not painful.
Joey Wahler (Host): So what causes this Condition?
Brian Janz, MD: So it's kind of unknown. there are some risk factors that you can have. But most of the time it's, sporadic or sometimes, you can have a genetic predisposition for it.
Joey Wahler (Host): How about links between Dupuytren's contracture and things like smoking or alcohol?
Brian Janz, MD: Risk factors for dut trends, can definitely increase with use of tobacco and or alcohol. So there are some associations with higher incidents if you, do use a higher level of alcohol, or if you do partake in tobacco intake.
Joey Wahler (Host): And so simply put what's the link there?
Brian Janz, MD: It's unknown. I believe there is a thought that it could be related to microscopic changes due to blood vessel changes such as with smoking. It causes a vasoconstriction of the small vessels. So that may predispose you to, or progression of the dupuytren's disease.
Joey Wahler (Host): So in terms of symptoms, doctor, you mentioned the differences in the skin. And then there also changes to the fingers as a result, right?
Brian Janz, MD: Correct. Yeah. As the cord, thickens, the fingers are going to contract in your two joints, your MP and PIP joints, which are two very specific joints in the hand, will contract down where you'll have the inability to extend the finger.
Joey Wahler (Host): And the fingers also sometimes can kind of start to curl inward?
Brian Janz, MD: Yep. And then once you hit a more severe stage of the disease process, it can curl all the way in and almost have the fingers where they're touching the palms of the skins, which can be fairly debilitating.
Joey Wahler (Host): Now before we go any further, why is Dupuytren's contractures sometimes called the Vikings disease?
Brian Janz, MD: Now that's because from an ancestral standpoint, people of Northern European descent do have a higher risk for the disease. Now the disease is across pretty much all ancestors, but there is a higher predisposition in Northern Europeans descents.
Joey Wahler (Host): And how is Dupuytren's contracture usually treated?
Brian Janz, MD: So initially for the early on stages, we treat it conservatively. If you have a nodule or you have a cord where you're not contracting a joint, we usually leave it alone. And the reason we do that is because if we wind up manipulating the skin in the early processes, sometimes a scar tissue that forms is going to be worse than the actual dunpuytren's nodule or small cord that forms.
So unless there's a specific reason to go after it such as significant. Pain or other issues. We usually leave it alone in those stages. Once we get what's called a positive tabletop test, which means that the fingers are starting to contract or curl in where you can't extend it out, your fingers out. Then that's when we would then treat it either with injections of medications or with surgery.
Joey Wahler (Host): And speaking of surgery, what might that entail?
Brian Janz, MD: So actually one good option before we actually get the surgery are DiaFlex injections. So that is a newer treatment that we've been using in which it's non-surgical, where we will inject a medication. And several days later manipulate the cords. The vast majority Dupuytren's disease, even with fairly significant cords can be treated in nonsurgical fashion.
So definitely a huge step forward when it comes to, medical technology in treatment of this disease and then if that doesn't work or if you're not a candidate for it, then there are surgical options where we'll excise the dupuytren's disease, and, zigzag the skin in order to, treat the contractures.
Joey Wahler (Host): Now you alluded to it a bit, but to be sure if left untreated, how bad can this condition get?
Brian Janz, MD: It can get pretty bad with regard to the contractures, fingers can curl into the palms where it really causes a deformity and decreased function involving the hand. So when it comes to Dupuytren's disease, although we don't treat it aggressively during the early stages, it's pretty important to treat this in the middle stage before it gets too severe because the outcomes I think are much better.
Whether or not you're treating non-operatively with DiFlex injections or with the excision and adjacent tissue transfer. So being able to get in and see a hand surgeon and really have them evaluate it and hit that nice medium area of treatment, in order to maximize outcomes, I think is really important with this disease.
Joey Wahler (Host): Indeed. So let me ask you about that. If someone looks down at their hand and sees the changes, that have taken place, when do you know that it's time to see a doctor?
Brian Janz, MD: Anytime there's a concern involving the nodules or involving the cords, I think it's time to come in so we can start the discussions early about the different treatment options. If you have a trigger finger, which is sometimes associated with dues disease, where the finger's locking or popping then I think that's a great time to come in so we can evaluate it.
Because sometimes steroid injections can help with the trigger fingers, or we can look and see how bad the disease process is. And then of course, if you have a severe contracture, there's still options, but it may be a little bit more reconstruction associated with that. So yeah, if there's any concerns with Dupuytren's, I think coming in early is a great idea.
Joey Wahler (Host): Indeed a different use of the term trigger finger there, by the way as well. Let me ask you this because it's where I started and a great place to end. I think, to bring things full circle, this condition gets its name from a famous French surgeon, Geome Dupuytren who performed its first successful surgery way back in the 1830s. Right?
Brian Janz, MD: Absolutely.
Joey Wahler (Host): So a little history lesson there as well as valuable medical information as well doctor. Well folks we trust you're now more familiar with Dupuytren's contracture. Dr. Brian, Janz. Thanks so much.
Brian Janz, MD: Oh, thanks for having me today.
Joey Wahler (Host): And for more information or to make an appointment, please visit MDbonedocs.com. Again, that's MD B O N E D O C S.com. And that was a Bone That's Fixed. If you found this podcast helpful, please share it on your social media. Hoping your health is good health. I'm Joey Wahler.