Xiaflex Injection For Dupuytren Contracture – Dupuytren’s contracture is named after Baron Guillaume Dupuytren, a French surgeon who lived in the 1800s. In Dupuytren’s contracture, the normally thin, flexible fascial muscles in the palm of the hand become thickened with scarring. A cord-like scar grows on the palms of the hands and fingers. This process can cause the fingers to gradually “pull out” or bend into the palm. This makes it difficult to straighten the fingers. Over time, bonds can develop between the joints that make it difficult or impossible to fully straighten the finger. This is called “manipulation of change”. Dr. Erickson treats patients with Dupuytren’s contractures in Raleigh, North Carolina.
Dupuytren’s disease is usually seen in men in their 40s or 50s. Related processes can cause leg cramps (Ledderhose disease) and male genitalia (Peyronie’s disease).
Xiaflex Injection For Dupuytren Contracture
The cause of Dupuytren’s disease is not fully understood, but genetics is often involved. Patients of Northern European or Scandinavian descent are at higher risk. For this reason it has been called the “Viking disease”. It is rare in people from Africa and Asia. It has not been shown to be associated with trauma. This may be an increased risk in patients with diabetes, heavy drinking and alcohol abuse.
Dupuytren’s Contracture > Fact Sheets > Yale Medicine
Dupuytren’s disease is usually a slowly developing process. People notice a thick lump or “nodule” in the palm of the hand that may develop into a hard band or “string” that extends to the finger, especially the ring and little fingers. Sometimes the nodule can be painful to touch with the hand, but most people with Dupuytren’s disease have no pain. The condition can affect both hands. Some infected patients report difficulty putting on gloves, reaching into pockets, or shaking hands.
Unfortunately, there is no “cure” for Dupuytren’s disease. The treatment is aimed at correcting the joints of the fingers and improving the function of the hands. This can be done by various methods. Maintenance doesn’t always fully fix contracts, and contracts can come back over time. The goal is to maximize the craft while minimizing the risks of complications.
Many people with Dupuytren’s disease have a mild form of the disease and may not develop severe hand contractures. All that is needed for these patients is education and awareness. An examination should be considered when you cannot keep your arms still on the table (table test) or when your life is affected.
Clinique Chirurgicale De Laval
Tender Dupuytren’s nodules in the palm may be injected with a corticosteroid medication (Kenalog) to soften the nodules and cause them to shrink. Some nodules may shrink in size with this procedure, but the nodules may grow back over time.
Radiation therapy is controversial. This is more popular in Europe. Some oncologists treat patients with Dupuytren’s disease early in the hope of slowing disease progression, but this treatment carries potential risks.
In more moderate or severe cases, changing the contracts can interfere with the craft. If quality of life is affected, additional treatment may be recommended. There are several techniques described for the treatment of Dupuytren’s contractures. Three popular procedures are described below and will be chosen based on the patient’s condition and medical history. Each method has pros and cons. No single regimen has been proven to be best for all patients.
Dupuytren’s Contracture Treatment Archives
1. Needle aponeurotomy (NA) is a minimally invasive procedure performed under local anesthesia in the office. Using the tip of the needle, the inner shell of the palm is perforated several times. The fingers are then manipulated to tear the fibers, allowing the fingers to straighten. This process takes place in the office. There are some risks: skin tearing, irritation, pain, bruising and swelling at the injection site are common. These symptoms usually resolve and heal within a few days. More serious complications such as infections, nerve injuries and torn tendons are very rare. This technique was developed in France in the 1980s and has recently gained popularity in the United States. Not everyone is a candidate for this procedure. This is the minimally invasive treatment for Dupuytren’s disease and the procedure has little downtime. Repair prices are high, but the process can be repeated in the future for recurring contracts.
2. Collagenase injections (Xiaflex) were approved by the FDA for use in the United States in 2010. This minimally invasive procedure involves injecting an enzyme to dissolve the collagen fascia fibers. The injection is done in the hospital and is followed by finger manipulation to tear the fibers about 2-3 days later using local anesthesia. This allows the fingers to straighten. Like NA, collagenase injections are not dangerous. Burning, pain, itching and swelling of the hands and wrists are common. Bruising or tearing of the skin may also occur, but these usually heal on their own within a few days. Ruptures of the flexor tendons of the finger are rare (less than 1% of patients), but if they occur, it is a serious complication. Adverse reactions to the drug are also possible. The collagenase drug Xiaflex is expensive, but most insurance plans usually cover it. Not all patients are good candidates for this procedure. Repair rates are high, but the process can be repeated in the future for recurring contracts.
3. Fasciectomy surgery is an outpatient procedure performed in an operating room that involves incisions in the palm of the hand and/or fingers to remove selected portions of diseased tissue. This procedure is commonly performed for Dupuytren’s disease today. During the operation, the contracted fascia is removed while the nerves and blood vessels are protected. Sometimes a small skin needle is used to replace an area of diseased skin. Bleeding, infection, wound healing problems, swelling, and nerve injury/bleeding are all possible risks with any surgery, including Dupuytren’s fasciectomy surgery. The results of surgery usually last longer than the results of NA or Xiaflex. Many patients have positive results that last a lifetime.
What Is Dupuytren’s Contracture?
After injection procedures (NA) or collagenase injection, patients are encouraged to carefully perform finger movements (rotation and straightening of fingers) guided by the therapist. These exercises are done several times a day at home/work. Use of hands is allowed if pain allows, avoid heavy lifting for one week. Swelling and tenderness from the procedure should improve within a few days. Recovery is faster with NA or Xiaflex collagenase treatments compared to surgery.
After fasciectomy surgery, the arm is protected with a plaster cast for the first few days. The rod was removed at the hospital and manual therapy was started. Hand care is very important in recovery. This includes range of motion exercises, use of a splint, and daily wound care. Ulcers on the palm usually heal within 3 weeks with this procedure. Removable splints are worn at night for several months to prevent premature aging. A gradual return to activities is expected in 4-6 weeks as the pain and swelling from the surgery improves.
Procedures performed for Dupuytren’s contractures improve finger range of motion and hand function for many years in many patients. Patients with moderate to severe contractures of the proximal interphalangeal joints (PIP) are difficult to recover. Over time, most patients develop some degree of joint contracture mobility. In other words, Dupuytren’s contracture can come back. Most studies report a lower recurrence rate with surgery than with less invasive techniques such as Xiaflex and NA.
Have Dupuytren’s Contracture? Xiaflex May Help.
Video courtesy of the American Association for Surgery of the Hand. Image copyright Dr. John Erickson If you have Dupuytren’s finger, here’s what you need to know about your treatment options to help relieve and improve your quality of life.
If one of your fingers, especially your ring or little finger, is stuck in a bent or crooked position, you may have what is known as Dupuytren’s contracture or Dupuytren’s disease. This is also called the trigger finger.
Dupuytren’s syndrome is a deformity of the hand that develops over many years and is not dangerous, although it can be quite painful or uncomfortable and may return after treatment. When you have Dupuytren’s disease, there is too much collagen in the hand and your body is unable to break it down properly. Excess collagen forms into hard bumps or cords that pull on the fingers, leaving them in a curled position.
Dupuytren’s Disease (viking’s Disease)
Dupuytren’s disease can affect any of your fingers, but it is more likely to affect the ring finger and little finger. This can make everyday tasks that require proper use of your hands difficult.
Because Dupuytren’s disease is not considered dangerous, many people ignore the early symptoms and refuse to get a medical diagnosis or treatment. However, Dupuytren’s can have a significant impact on daily life, making simple tasks or incredibly difficult. Dupuytren’s can reduce the normal functions of the ring and pinky fingers, making it very difficult to grasp, hold, rotate, or use most hand tools. Dupuytren’s can have a very negative impact on work, cell phone use, driving, exercise, cooking, cleaning, and much more.
If you suspect you may have Dupuytren’s contracture, it is important to see a doctor
Dupuytren’s Disease: Using Needles More Across The World
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