Dupuytren’s (pronounced, “doo puh trenz”) contracture is a progressive hand condition that causes a thickening of the tissue that is just below the skin of the palm. An abnormal build-up of collagen thickens into a rope-like cord in the palm that slowly causes the fingers to curl to the point where they cannot be straightened. Often mistaken for arthritis or other conditions, over time the tightening of the Dupuytren’s cord can significantly reduce your finger’s range of motion. The disease is hereditary and is also linked with cigarette smoking, vascular disease, epilepsy, and diabetes. If nodules or lumps are small, treatment is not needed. However, if a cord forms, the affected fingers will develop a contracture that can interfere with proper hand function. Treatment may be recommended at this point with either an injection of an enzyme or surgical excision, depending on the charactertistics of the contracture.
Treatment with Xiaflex
Today there is a new FDA approved treatment with a medication called Xiaflex that is proving to be highly effective. Xiaflex is a prescription medication used to treat adults with Dupuytren’s contracture once a cord can be felt in the palm. Xiaflex is an injectable solution of enzymes (purified collagenase clostridium histoliticum) that is injected directly into the Dupuytren’s cord. The enzymes break down the cord which allows the finger to straighten again.
Approximately 24 hours after the injection the patient returns to the doctor who will carefully extend the injected finger to help release the cord. Up to three injections may be given into the cord of an affected joint. Only one finger (and one joint) may be injected per treatment. If desired another finger may be addressed at a minimum of 30 days later.
Studies indicate that the majority of patients achieve a reduction in their contracture; many achieving complete or near complete reduction. The treatment has been shown to be more effective in the metacarpophalangeal joints (the lowest finger joints to the palm) than in the proximal interphalangeal joints (the middle joints of fingers).
Xiaflex is not right for every patient. Ask your physician if this treatment is recommended in your case.