It was reported recently by the Northern Echo that Dupuytren’s contracture, otherwise known as ‘Claw Hand’, will not be added to the list of diseases for which Industrial Injuries Disablement Benefit is payable[i]. This is in spite of a 2014 report, by the Industrial Injuries Advisory Council, which recommended that Dupuytren’s be prescribed to the list of compensable diseases[ii].
Dupuytren’s contracture, or Dupuytren’s disease, is a condition by which one or more of the fingers become bent in towards the palm of the hand. It is caused by thickening of the connective tissues in the palm. Tissue tends to thicken, initially, in a small nodule under the palm, which may feel tender. More nodules develop with time and can eventually form cords of tissue, which can contract and pull a finger towards the palm. This stage of the disorder is known as Dupuytren’s contracture. The contracture is usually painless, but will often be a nuisance, and can steadily become worse over time.
Figure: Dupuytren’s contracture (Source: NHS)
In the early stages of contracture, treatments such as radiation therapy, needle fasciotomy and collagenase injections may be recommended. Collagenase injection is a relatively new treatment option, and is recommended by NICE in non-clinical trial patients - but only if certain criteria are met[iii]. More serious stages of contracture may be treated by various surgeries, of which fasciectomy is the most popular. Success rates are generally quite high, though surgery does not remove the underlying disease, and recurrence is common.
The IIAC report found that, given sufficient exposure to hand-held vibrating tools, risks of Dupuytren’s disease and contracture can be more than doubled (the normal threshold employed by the Council when recommending prescription). Early (pre-contracture) stages of the disease are not significantly disabling and would be unlikely to qualify for benefit. For this reason, the Council recommended that only the contracture stage of the disease, when one or more fingers are held in the flexed position, be added to the list of prescribed diseases for which Industrial Injuries Disablement Benefit is payable. The report outlines a test that can be used as a simple screen to help identify which cases are this severe. Qualifying exposures would be those arising from work for ten years or more in aggregate that involves the use of hand-held powered tools whose internal parts vibrate so as to transmit vibration to the hand for at least two hours per day on three or more days per week.
Shortly before Christmas 2017, the Secretary of State for Work and Pensions was asked what progress has been made to include Dupuytren’s in the list of Industrial Injuries Disablement Benefit diseases[iv]. The response was:
‘After considering the recommendation made by the Industrial Injuries Advisory Council, we have decided not to add Dupuytren’s contracture to the list of prescribed diseases.’
It has now been reported that Alan Cummings, Miners’ Association secretary, has received an email from the Department of Work and Pensions, saying:[v]
‘Following publication of the Industrial Injuries Advisory Council (IIAC) recommendation to add Dupuytren’s contracture to the list of prescribed diseases for which Industrial Injuries Disablement Benefit is payable, the Department for Work and Pensions considered the proposal… The recommendation has been carefully considered but it has been decided not to add Dupuytren’s contracture to the list of prescribed diseases.’
Mr Cummings said the association will be co-ordinating efforts by groups and unions across the country to reverse the decision.
[i] Miners’ outrage over claw-hand compensation ruling. The Northern Echo. 27 February 2018. http://www.thenorthernecho.co.uk/news/local/northdurham/durham/16050012.Miners__outrage_over_claw_hand_compensation_ruling/ (Accessed 20 March 2018)
[ii] Dupuytren’s contracture due to hand-transmitted vibration. Report by the Industrial Injuries Advisory Council. Cm8860. May 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/308645/dupuytrens-contracture-report.pdf (Accessed 20 March 2018)
[iii] Collagenase clostridium histolyticum for treating Dupuytren’s contracture. NICE Technology appraisal guidance [TA459] Published 26 July 2017 https://www.nice.org.uk/guidance/ta459/chapter/1-Recommendations (Accessed 20 March 2018)
[iv] Industrial Injuries Disablement Benefit: Dupuytren’s Contracture: Written question – 119611 http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-12-14/119611/ (Accessed 20 March 2018)
[v] Ibid Northern Echo