Transcript
josh MacDonald: Hi, I'm Josh McDonald.
Miranda Materi: And I'm Brandon Materi and we are Ham Therapy Academy.
josh MacDonald: We decided to do a little quick journal article review thing here. We each took ah an article on kind of an interesting topic. So today I'm going to talk a little bit about an article I found that is, the title is, Likelihood of Future Dupuytren's Disease Intervention After Initial Treatment in the Same Digit, Other Digit, or Contralateral Hand.
Miranda Materi: Interesting. So for this article, were they talking about like the needle ponirotomies and the decollagenase and open procedures, or was it just standardized to one type of procedure?
josh MacDonald: It was fasciectomy and collagenase treatment. So specifically those two, and they had a total of 341 participants, and they were looking to see what percentage of these 341 people needed an additional treatment on the same digit,
Miranda Materi: Okay.
josh MacDonald: a different digit on the same hand or on the other side or on the contralateral hand. And so just kind of go through it. First of all, it is in the Journal of Hand Surgery. And I apologize, I'm going to butcher this author's name. i believe it's Bachaui, B-A-C-H-A-O-U-I.
josh MacDonald: um But it's in the recent 2026 Journal of Hand Surgery, if you're looking for it. Basically, they found that 42% of the patients underwent an additional treatment.
josh MacDonald: Specifically, 26% had within three and a half years had a treatment on the same hand, excuse me, on the same digit, an additional treatment on the same digit. 10% had an additional treatment on a different digit of the same hand.
josh MacDonald: And then 23% had a treatment on the other hand, a digit of some kind. And their point of doing this, they were looking at like, what are the chances that a patient who has one procedure for Dupratrins is going to need another?
josh MacDonald: And it's a pretty likely thing, 42%, that you're going to need another procedure. I thought it was surprisingly high that 26% needed it at about three and a half years on the same digit.
josh MacDonald: So when we're seeing these patients, that specifically the ones, and it said that delayed initial care was a high predictor of that follow-up on the same digit.
josh MacDonald: If you've got a patient who who, when you ask them their history, how long had this been a problem for?
Miranda Materi: Bye.
josh MacDonald: And they said like, oh, like 15 years. I had a guy say, I own my own company and could never take time off work. So for 15 years, that small finger was down, flexed and stuck. It's not a one and done. It's likely going to need, you know, volar plate is contracted and you've got flexor tendon issues and you've got pulley issues. That is likely not a one and done. The first procedure is just so you can get to all the structures.
josh MacDonald: Yeah.
Miranda Materi: Yeah. So when you're talking about this, that makes me think of like what my, or, and I'll ask you too, what's your takeaway from it? But I'm initially thinking, okay, I have a patient that maybe I'm seeing for something different, like even, uh, I don't know, distal radius fracture or something like that. And I noticed they have Dupuytrens then to make sure I provide education, like, Hey, if this gets worse or it gets severe, where you can't put your hand flat on the table. you need to seek treatment early as opposed to later on so you avoid this multiple procedure on that same digit.
josh MacDonald: Yeah, yeah, definitely. And getting it taken care of early. I used to tell patients 30 degrees, right? I would say like, that because that's what I learned when we worked at Mayo Clinic. If it's 30 degrees or more of an MCP or a PIP lag, then it reaches the doctor's threshold. But I've got some doctors that'll treat it very early to catch it.
josh MacDonald: Excuse me. So it doesn't become one of these issues.
Miranda Materi: Yeah. And that totally makes sense. Cause i think of our longstanding Dupuytren's patients where they have that PIP contracture and, you know, maybe it's been that way for a few years and you're like, well, you know, their central slip is all attenuated.
Miranda Materi: Even if we get their fingers straight, how is it going to stay straight?
josh MacDonald: Yeah.
Miranda Materi: Like the mechanics are so stretched out. They don't have the ability to keep it straight.
josh MacDonald: Yeah. Yeah. And what are some other comorbidities? If I know I've got a patient, like you said, I'm seeing from maybe a CMC arthritis and they are diabetic or they're a smoker, those were all things that that showed up on here as a likely indicator for a need for follow-up treatment for the same digit or other digits.
josh MacDonald: If I know they've got other comorbidities, stay on top of that, get that in early. Um, I've had some patients where I'm like, you look, I can see a little cord there. If you start to lose the ability to open that hand all the way, laying your hand flat on the table is big in the commercials that we see right now for college and ace.
Miranda Materi: thanks
josh MacDonald: But I feel like that's kind of a subjective thing. Cause you can, like, I can, I can kind of fit my hand flat or like I can shove it down and make it work. But like, can you open your hand up like up in space?
Miranda Materi: Yeah.
josh MacDonald: Yeah. Yeah.
Miranda Materi: Yeah. So what you would you say another, or what was your big clinical takeaway from reading this paper?
josh MacDonald: um I think, like you said, getting it in early. i think another interesting factor that indicated a likelihood for um recurrent treatment on another digit, same hand, whatever, was younger age.
josh MacDonald: That patients who present with it early are likely to present with multiple occurrences of it. And so that's that's an interesting, like usually we tell patients like, oh, if you get it taken care of when you're young, you're good to go. Like the younger, the better, right? In this case, if it's someone who's had an occurrence that is functionally limiting or posturally limiting early, they're likely going to have more of these pop up and they just need to stay on top of each of them and not let any one of them get too far.
Miranda Materi: Yeah. Well, then the the further it gets to, the more invasive, right?
josh MacDonald: Yeah.
Miranda Materi: So that's the other thing.
josh MacDonald: Yeah. Yeah. And, and like you said, with whether it's central slip attenuation or pulley issues, like the longer it's down there, the harder it is eventually to get back to a normal hand. And I've got a lot of patients who had let it go too long. and It was very, very aggressively flexed and they are thrilled to have only a 45 degree flexion contracture.
josh MacDonald: Like That's fantastic. That's, you know, they don't want to do any more therapy. I'm super happy with the outcomes. All right, great. If you're happy with it, that's what matters most. I think, man, they're so far.
josh MacDonald: worse than they could have been if they had either gotten it taken care of sooner or maybe went back in for unintended revision.
Miranda Materi: Thank you.
josh MacDonald: Maybe that there's some education that says, you know, you can you went in for one, that's great. We're only going to make you maybe 15 to 20% better than you come out of this procedure with, but know that there may be some value to a repeat repeat procedure if you are open to that and you feel like you want some more progress.
Miranda Materi: Yeah, i mean I think what people sometimes don't realize is, you know, people deal with it and it's such a sh like it happens over ah such a like usually it's not dramatic, like you don't go from zero to 45, right? You go from zero to five and then the next year it's 10. So sometimes it's this very slow process. So people don't even realize that it's gotten so severe.
josh MacDonald: Yeah.
Miranda Materi: You know, so I've had that, but then on the other side, I've had where it's advanced so quickly.
josh MacDonald: Yeah.
Miranda Materi: Right. And it just seemed like there was an injury or something kind of like catapulted that to become severe. And I don't know if you remember this patient, but it was when we worked together like 10 years ago in that high volume trauma clinic, but the surgeon did, um, the fasciectomy, um, and she continued to have this severe PIP contracture. And she begged the doctor to amputate her small finger.
Miranda Materi: do you remember this?
josh MacDonald: Yes. Yes. Yeah.
Miranda Materi: And it happened, he amputated it. And I was like thinking like, that seems so dramatic and drastic for Dupuytren's, right? But she was so disabled by her contracture.
josh MacDonald: Yeah.
Miranda Materi: She said she couldn't do anything. She didn't even want that finger anymore.
josh MacDonald: Yeah. And, and that's, you're right. That's a very severe extreme end point, but that was better for her. She could do more stuff without it.
Miranda Materi: Yeah.
josh MacDonald: Yeah. Yeah.
Miranda Materi: So it's just interesting, you know, because I feel like we can see a whole spectrum of patients that have Dupuytren. So I think anything we know and any literature we can provide to our patients can be helpful or disseminate to them in a way that's easy to understand.
josh MacDonald: Yeah, yeah. Interestingly, I heard that um Canada has actually, i don't know if it's official or if it's something they're working towards, but they're trying to, I'll say, outlaw or prohibit the use of collagenase treatment.
josh MacDonald: And so doctors now are starting to treat patients at the very, very early stages. five to 10 degrees of flexion contracture. And doctors are saying, let's go in and do a fasciectomy now.
josh MacDonald: Let's go in and address it now or the aponeurotomy, but they're not allowed to use the medication. And I didn't catch why. um so I'd be interested if anyone has any insight on that to share it with us.
josh MacDonald: And I don't, unfortunately, i don't remember the source. It was a while ago that I heard it. So I wanted to look into that a little bit more to see like, that would that would be an interesting trend for all care to say like, well, maybe if we dealt with all these patients at five or 10 degrees, it could all be a very simple, maybe an aponeurotomy or something like that.
Miranda Materi: Interesting.
Miranda Materi: Yeah. I wonder if it was the expense of the injection.
josh MacDonald: That might've been an ah the Canadian insurance system preventing it.
Miranda Materi: Yeah. I wonder if that'd be interesting to know.
josh MacDonald: Yeah. Yeah. Yeah. Yeah. Well, hopefully this brings a little information to you from about Dupuytrens, but we always encourage people to stay interested in reading articles, stay up to date on the journal articles out there. there's always good stuff for us to learn for care. And if you have any questions, reach out to us on our social media platforms at Hand Therapy Academy.
