TREATING DUPUYTREN’S DISEASE WITH XIAFLEX
DUPUYTREN’S DISEASE AND XIAFLEX
A hand deformity that usually develops over years, Dupuytren’s disease affects the layer of tissue that lies under the skin of the palm. Knots of tissue form under the skin, eventually creating a thick cord that can pull one or more fingers into a bent position. Firm pits, nodules, and cords may develop that can cause the fingers to bend into the palm which gives the condition the name of Dupuytren’s contracture.
The affected fingers cannot straighten completely, which can complicate everyday activities like placing ones hands in ones pockets, putting on gloves or shaking hands.
A collagenase used for the treatment of Dupuytren’s contracture, Xiaflex remains a popular treatment option. A type of proteins that perform functions, enzymes reduce the energy requirements of a chemical reaction. A collagenase enzyme, Xiaflex breaks down the structure of collagen at the molecular level. Patients should always seek out the care of a board certified orthopedic hand specialist to use Xiaflex. The orthopedic hand specialist injects the collagen knot or cord within the hand with the Xiaflex which breaks down the excess collagen in the area, therefore eliminating or decreasing the size of the knot.
SYMPTOMS OF DUPUYTREN’S CONTRACTURE
The initial lumps may produce discomfort that usually resolves, but Dupuytren’s disease typically does not cause pain. In most cases of Dupuytren’s contracture, the contracture causes more annoyance than actual pain. The patient may first notice an issue with their hand due to having difficulty placing the hand flat on an even surface like a tabletop. When the tissues within the hand thickens and the fingers contract into the palm, one may notice increasing difficulty with activities like washing, wearing gloves, shaking hands, and putting hands into pockets. The knotted cord may also visibly stick out of the skin, appearing like a bump within the palm.
In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to the fingers. When the cords tighten, the fingers may pull toward the palm, sometimes severely.
WHY CHOOSE A XIAFLEX COLLAGENASE INJECTION FOR DUPUYTREN’S CONTACTURE
Orthopedic hand specialsits use collagenase clostridium histolyticum (brand name XIAFLEX) enzyme injections to treat Dupuytren’s contracture. The enzyme dissolves a small portion of the thick cord allowing the physician to straighten the finger. The treating physicians dictates whether or not a patient should receive Xiaflex. Xiaflex may not work on every patient and doctors can utilize other treatment options. A non-surgical resolution for the treatment of Dupuytren’s contracture, Xiaflex injections works to restore mobility to the hand without a painful surgical recovery.
WHAT TO EXPECT WITH A XIAFLEX INJECTION
When seeking treatment for Depuytren’s contracture (or disease), patients should seek care from a board certified hand and wrist specialist. The doctor begins with a physical examination of the patient. The doctor goes over all medical history and daily activities. The doctor may perform physical tests on the affected hand but many can visibly see the knot or cord after simply looking at the hand. To rule out any other issues within the hand, the physician may order diagnostic testing. Once the doctor diagnoses the patient with Dupuytren’s disease, the physician discusses treatment options. If the doctor determines Xiaflex can help the patient, the physician must work to get the insurance company to help pay for the injection. Getting the insurance company to give approval for use of the enzymatic treatment remains the greatest hurdle in the treatment of Dupuytren’s disease using Xiaflex. Although Xiaflex has been on the market for a fair amount of time, the price has remained on the higher end of available treatment options. Once approved, the treatment takes place in the office of the physician.
To start the procedure, the doctor numbs the hand so the patient does not feel pain. The hand specialist places the injection into the thick cord that causes the finger to contract. The night after the injection, the hand may bruise and swell. Between one and three days following a Xiaflex injection, the patient must have a clinic follow up with the treating physician. During the follow up visit, the physician checks the injection site. After applying a numbing agent, the physician then straightens the finger. The weakened collagen cord snaps when the doctor manually straightens the finger and restores the flexibility of the hand.
Each physician differs but in most cases the treating physician prescribes a physical therapy protocol. Physical therapy helps the patient strengthen the hand and maintain flexibility so the finger does not contract again.