Patient #2 is a male in his third decade with a strongly positive family history (Fig. 24.2).

Patient #3 is a gentleman early in his eighth decade who presented for consultation about 4 years after surgery done elsewhere for left little finger PIP contractures. He was referred to our clinic because he said he would “never again” go through an operation, but he was most interested in alternative approach to gaining correction. At the consultation visit, he was given verbal and written education about the nature of the disease and recurrences after any form of treatment. He was actually quite well informed after his surgical experience and subsequent Internet research. He had learned about enzymatic treatment and asked to pursue that option. Figure 24.3a, b shows the finger deformity at presentation, and Fig. 24.3c 1 year after manipulation.

I have seen him most recently, almost 36 months after treatment, and found definite recurrence in the little finger proximal phalanx and some progression in the third and fourth ray midpalmar cords, but he has yet no significantly dysfunctional problems although he will continue to be followed.

Patient #4 represents a man in his seventh decade with a significant left little finger PIP joint contracture (Fig. 24.4). Figure 24.4a, b shows his deformity prior to treatment. Figure 24.4c depicts the hand 13 months after enzymatic fasciotomy and manipulation with near complete extension of the PIP joint and full flexion in all fingers. Figure 24.4d shows the hand at 18 months FU.