Dupuytren’s Contracture Disability Insurance Claim Denials

Why do Insurance Companies Deny Claims for Dupuytren’s Contracture?

Understanding these potential obstacles can help patients better navigate the insurance process, advocate for necessary treatments, and, if needed, successfully appeal denials. Jonathan M. Feigenbaum can help. He has a history of getting ERISA plan participants and those with individual disability insurance policies who have had claims denied eventually get paid. Hiring an attorney who is knowledgeable with not only the law but the quirks of each insurance company may help you get paid more quickly. For a complimentary evaluation, call Jonathan at (617) 357-9700.

What is Dupuytren’s Contracture?

Dupuytren’s Contracture is a hand deformity that develops over years, affecting the layer of tissue under the skin of the palm. Named after the French surgeon Guillaume Dupuytren, who first described the condition in the 19th century, it primarily impacts the fascia—a layer of connective tissue that supports the skin and helps with hand movement.

Pathophysiology

Dupuytren’s Contracture begins with the thickening and tightening of the fascia in the palm. Initially, small nodules may form under the skin, often near the base of the fingers. As the condition progresses, these nodules can develop into thick cords, pulling one or more fingers (most commonly the ring and little fingers) into a bent position. Once bent, the affected fingers cannot be fully straightened, significantly limiting hand function.

Risk Factors

The exact cause of Dupuytren’s Contracture is not well understood, but several risk factors have been identified. Genetics play a significant role; the condition is more common in people of Northern European descent, particularly those with a family history of the disease. It is also more prevalent in men than in women, and the risk increases with age, typically appearing after the age of 50. Other risk factors include diabetes, smoking, excessive alcohol consumption, and certain medications, though these associations are not fully understood.

Symptoms

The primary symptom of Dupuytren’s Contracture is the inability to fully extend one or more fingers. This typically occurs without pain, although the initial development of nodules may cause some discomfort. The condition progresses slowly and can eventually make everyday tasks—such as shaking hands, putting hands in pockets, or even wearing gloves—difficult or impossible.

Diagnosis

Diagnosis of Dupuytren’s Contracture is primarily clinical, based on the appearance of the hand and the characteristic thickened cords or nodules under the skin. Physicians may perform a simple physical exam, such as the “tabletop test,” where the patient tries to place their hand flat on a table. If the hand cannot be laid flat, it is a positive indication of the contracture.

Treatment

There is no cure for Dupuytren’s Contracture, but several treatments can manage the symptoms and improve hand function. Mild cases may not require treatment beyond observation. In more severe cases, options include:

• Needle Aponeurotomy: A minimally invasive procedure where a needle is used to break the thickened cords, allowing the fingers to straighten.
• Enzyme Injections: Collagenase injections can dissolve the thickened tissue, followed by manipulation of the hand to break the cords.
• Surgery: For advanced cases, surgical removal of the affected fascia may be necessary to release the contracture.

Post-treatment physical therapy is often recommended to restore as much function as possible. Recurrence is common, and some patients may require additional treatments over time.

Getting a Medical Diagnosis for Dupuytren’s Contracture

Diagnosing Dupuytren’s Contracture involves a series of steps aimed at evaluating the symptoms and severity of the condition. The process typically includes a clinical evaluation, a physical examination, and possibly additional diagnostic tests.

1. Recognizing Symptoms: The condition often begins with the formation of small, painless lumps or nodules in the palm, usually near the base of the fingers. Over time, these nodules may thicken and form tight cords of tissue that pull the fingers, most commonly the ring and little fingers, into a bent position. This contraction can make it difficult to fully extend the affected fingers, eventually limiting hand function.
2. Consulting a Healthcare Provider: If you notice symptoms that suggest Dupuytren’s Contracture, the next step is to consult a healthcare provider, typically a primary care physician or a specialist like a hand surgeon or an orthopedic surgeon. During the initial consultation, the doctor will ask about your medical history, including any family history of Dupuytren’s Contracture, as the condition is known to have a genetic component. They will also inquire about any lifestyle factors, such as smoking or alcohol use, which are known risk factors.
3. Physical Examination: The diagnosis of Dupuytren’s Contracture is primarily based on a physical examination. During the exam, the doctor will inspect your hands for the characteristic nodules and cords associated with the condition. They will also assess the degree of finger contraction and how much it affects your hand function. A common test used in the diagnosis is the “tabletop test.” In this test, you are asked to place your hand flat on a table. If you cannot fully flatten your hand due to the contracture, it is a strong indication of Dupuytren’s Contracture. The doctor may also check the range of motion in your fingers and assess the extent of the contracture to determine the severity of the condition.
4. Imaging Tests: In most cases, a physical examination is sufficient to diagnose Dupuytren’s Contracture, and imaging tests are not usually required. However, in certain situations, the doctor might order imaging studies like an ultrasound or an MRI to get a clearer view of the affected tissue, especially if the diagnosis is uncertain or if there is a need to plan for surgery.
5. Additional Considerations: The doctor may also consider other conditions that can cause similar symptoms, such as trigger finger, arthritis, or other types of hand deformities. They will rule out these conditions through the physical exam and possibly through additional tests if necessary.

What Are the Treatment Options for Dupuytren’s Contracture?

Once Dupuytren’s Contracture is diagnosed, the treatment plan depends on the severity of the condition, the level of hand function impairment, and the patient’s overall health. There is no cure for Dupuytren’s Contracture, but several treatments can help manage symptoms and improve hand function.

1. 1. Watchful Waiting: In the early stages of Dupuytren’s Contracture, especially if the symptoms are mild and do not significantly affect hand function, the doctor may recommend a watchful waiting approach. This involves regular monitoring of the condition to see if it progresses. During this time, patients are advised to avoid activities that might worsen the contracture, such as repetitive hand movements or gripping actions.
   2. Non-Surgical Treatments: For patients with mild to moderate contractures, non-surgical treatments may be effective. These include:
      • Needle Aponeurotomy: This minimally invasive procedure involves inserting a fine needle into the thickened cords of tissue to break them up, allowing the fingers to straighten. It is performed under local anesthesia and has a short recovery time. However, there is a risk of recurrence since the underlying disease process is not
   3. Surgery.