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. It is 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, you may not need treatment. However, if a cord forms, the affected fingers will develop a contracture that can interfere with proper hand function. Physicians may recommend treatment at this point with either an injection of an enzyme or surgical excision, depending on the characteristics of the contracture.
Today there is an FDA approved treatment for Dupuytren’ contracture 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.
Treatment with Xiaflex® is a 3-day process that includes the injection of the solution, finger extension, and fabrication of a night-time splint.
Approximately 24 hours after the injection, your physician will carefully extend the injected finger to help release the cord. As many as three injections may be given into the cord of an affected finger or joint. No more than one finger and one joint may be injected per treatment. Patients must wait a minimum of 30 days to have Xiaflex® treatment for another finger.
Studies indicate that the majority of patients achieve a reduction in their contracture. Many experience complete or near complete reduction. The treatment shows 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.
Remove all jewelry from the affected hand, including rings, watches and bracelets. There is a certain amount of swelling and bruising that typically occurs following a XiaflexÒ injection.
- Your hand will be placed in a soft dressing to provide some padding over the injection site.
- Keep your hand elevated as much as possible to minimize swelling. At bedtime you can elevate the hand with one or two pillows.
- Do not use ice for the first 48 hours after the injection of Xiaflex® as this may reduce its efficacy.
- While your cord may release spontaneously, do not attempt to forcefully disrupt or straighten the injected finger. You will see your physician in one to seven days for a finger extension procedure which is performed under local analgesia.
- Following the finger extension, a hand therapist will fit you with a custom splint to wear at night to keep the finger straight. This should be worn for as many as four months.
- Your hand therapist will prescribe a series of daily finger flexion and extension exercises to improve your finger motion and limit the formation of scar tissue.
- Do not perform any heavy gripping or weight lifting for one month after the injection.
POSSIBLE SIDE AFFECTS
Xiaflex® treatment is likely to cause temporary swelling, bruising, bleeding, itching and/or pain at the injected site and surrounding tissue. Bruising may occur all the way up the arm. This typically resolves within a few days. Transient swelling of the lymph nodes (glands) in the elbow or underarm may also be noted.
- Small skin tears at the injection site may occur following the finger extension procedure and will typically heal within a week. If a skin tear develops, it is covered with a small dressing until healed.
- Rare but serious complications of Xiaflex® injection include tendon ruptures and ligament injury. In the initial controlled trials, flexor tendon rupture was observed in 0.3% of 1,082 patients. If a tendon becomes weak and ruptures, surgery may be required.
- Call your doctor right away if you are unable to bend your finger (towards the wrist) after the swelling goes down.
- Allergic reactions are possible after an injection of Xiaflex® because it contains foreign proteins. If you experience a swollen face, breathing trouble or chest pain call 911 or go to the hospital ER.
- NOTE: Recurrence of contracture can occur after either surgery to remove the entire cord or after Xiaflex® injection to dissolve the cord. Xiaflex® treatment can be repeated if recurrence develops.
- If you have questions for your physician, please send a message via the online ONS Patient Portal. Your message will be answered promptly.
Video Demonstration of Dupuytren’s Treatment with Xiaflex
Watch the video below to get a general sense of the Xiaflex procedure. Please note that each procedure is individual to a patient’s particular condition so your treatment with Xiaflex may differ according to your physicians judgement.