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Getting a grip on hand condition

For Robert Le Clair, the first clue that something was not right with his left hand came when he was getting ready for a round of golf.

"I didn't notice it until one day I tried to put on a golf glove," said Le Clair, recalling the day some six years ago. "One finger on my left hand was curled -- the baby finger."

Unable to pull on his glove, Le Clair sought help from a doctor.

A retired industrial arts teacher, he suspected he might have a case of "trigger finger," perhaps caused by overuse of his hands during his career at John F. Kennedy High School in Cheektowaga.

But that wasn't the case.

Le Clair, now 64 and a resident of Orchard Park, was surprised to learn that he has a condition called "Dupuytren's contracture" in his hands. The problem was more pronounced in his left hand; now his right hand also is showing signs of it.

"There was no pain involved, nothing like that. I still had grip. I still had strength in the hand," said Le Clair. "It had been progressing, but I didn't notice it."

Dupuytren's contracture is a medical condition in which the cords of muscle and connective tissue running across the hand tighten over time, causing the fingers to curl in -- or "contract" -- upon themselves.

It can lead to problems doing everyday tasks.

According to an Amherst doctor who treats the condition -- and who diagnosed and treated Le Clair -- the contracture tends to appear more often in men than women, and especially those of Northern European heritage, including Welsh, Scottish and English ancestry.

Dupuytren's also has a strong tendency to run in families, said Dr. Raymond Schultz at the Center for Plastic Surgery on Main Street in Williamsville.

Schultz said research shows it affects about 6 percent of the population overall.

"It's not one of the most common situations you see on the hand, but it's not completely rare," said Schultz. "I'll usually see about two or three cases a month in my office."

People usually notice they have some sort of problem with their hands when, like Le Clair, they can't grip an object, perform a task or shake hands the way they used to, said Schultz, who has treated people with the condition for 15 years.

"People don't know they have Dupuytren's, but they know something is wrong with their hands," the doctor said. "They know something is going on. You lose the ability to straighten the finger out."

Sometimes the symptoms take years to develop, but in other cases they can develop almost overnight, he said.

There are several treatment options -- which to use depends on the individual's circumstances and how far and how fast the problem has progressed, among other factors, Schultz said.

Surgery: The traditional form of treating the condition, a surgery on the hand to repair Dupuytren's contracture, can take several hours and usually requires rehabilitation afterward, Schultz said. It comes with the standard risks inherent in invasive surgical procedures, such as the potential for infection at the wound site, he said.

*Enzyme injections: The newest form of treatment for Dupuytren's. Schultz used an enzyme injection called Xiaflex to treat Le Clair last fall. This method was approved for use on the public in February 2010. He said the treatment, which is done over two days, uses an enzyme substance to dissolve the thick cords of tissue in the hand.

"In a very controlled amount, we can inject this substance that will eat up the cord," the doctor said. "Once the cord has been dissolved, you see the patient the next day and the cord has become soft and pliant."

For Le Clair, a combination of surgery and enzyme injection proved to be the ticket to restore function in his left hand.

His surgery, a few years ago, took several hours and required rehab afterward. The enzyme injection, which he received last year, brought some pain and side effects, but Le Clair recovered speedily.

"It did dissolve the cord to the point where it's no longer noticeable," he said. "I have a pretty good cord [forming now] on my right hand, and if it goes into contracture, I would definitely choose this procedure again."


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