Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
A Dupuytren's contracture is a localized scar tissue formation in the palm.
The precise cause of a Dupuytren's contracture is not known.
A Dupuytren's contracture is sometimes inherited.
A Dupuytren's contracture can limit extension of the affected finger.
The treatment of a Dupuytren's contracture depends on the severity and the underlying condition of the affected individual. Treatments include stretching, heat, ultrasound, local cortisone injection, surgical procedures, and collagen injection.
A Dupuytren's contracture is a localized formation of scar tissue around the tendons that flex the fingers beneath the skin of the palm of the hand. The scarring accumulates in a tissue (palmar fascia) that normally covers the tendons that pull the fingers to grip. As a Dupuytren's contracture progresses, more of the fascia becomes thickened and shortened. Dimpling and puckering of the skin over the area eventually occurs and ultimately can make it impossible to fully extend the fingers (as in laying the hand flat on a tabletop).
How fast does a Dupuytren's contracture develop?
A Dupuytren's contracture usually progresses slowly over years. In rare cases, it can progress more rapidly.
What are the causes and risk factors of a Dupuytren's contracture?
A Dupuytren's contracture can be inherited. In medical terms, the inherited form of a Dupuytren's contracture is transferred in the family as a so-called autosomal dominant trait with incomplete penetrance and partial sex-limitation. This means that the gene for a Dupuytren's contracture is not on an X or Y chromosome (sex chromosome) but on one of the other 44 chromosomes. Consequently, one version of the gene is enough to cause the disorder (it is dominant), but not everyone who has the gene has the disorder (the gene is not fully penetrant), and the disorder is most frequent in males (the gene expression is partially limited to males).
Typically, a Dupuytren's contractures occur in males over the age of 50. It is more common in males of Northern European descent. The ring and little finger are affected most commonly.
Xiaflex is an injectable formulation of purified collagenase derived from the bacterium, Clostridium histolyticum. It is used for treating Dupuytren's contracture. A Dupuytren's contraction is caused by an abnormal accumulation of collagen (scar) in the tissue beneath the skin of the palm of the hand. Xiaflex breaks down excessive collagen by disrupting its chemical structure.