title: Efficacy and tolerability of Day 2 manipulation and local anaesthesia after collagenase injection in patients with Dupuytren's contracture.
abstract: In clinical trials, treating Dupuytren's contracture with collagenase injection involves manipulation the day after injection, without local anaesthesia. We evaluated the efficacy and tolerability of manipulation 2 days after injection with local anaesthesia. Forty-five patients received 50 injections into cords contracting metacarpophalangeal and proximal interphalangeal joints; follow-up visits were at 3 and 14 weeks. For the metacarpophalangeal joints there were >90% reduction in contracture at both visits. The proximal interphalangeal joints that improved spontaneously after metacarpophalangeal injection or received direct injections showed 51-55% reduction in contracture. Changes in scores on the Patient Evaluation Measure suggest that patients perceived improvements in their hand function was good and they were satisfied with the procedure. Collagenase and local anaesthesia injections were well tolerated; adverse events were localized to the injection site and were mild and transient in nature. These findings provide another viable option for practising surgeons and may help with the logistics of patient care.
authors.affiliation: Stepping Hill Hospital, Stockport, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Manning
authors.affiliation: Wrightington Hospital, Lancashire, UK.
authors.forename: R
authors.initials: R
authors.lastname: Delaney
authors.affiliation: Wrightington Hospital, Lancashire, UK mikehayton@gmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hayton
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D004387:Dupuytren Contracture / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D003012:Microbial Collagenase / Q000627:therapeutic use*; D008875:Middle Aged; D064746:Therapy, Soft Tissue; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase
keywords: Collagenase; Dupuytren’s contracture; Dupuytren’s disease; changes in fixed-flexion contracture; day 2 manipulation; finger extension procedure; local anaesthetic; manipulation; patient evaluation measure