Xiaflex Injections Treat Dupuytren’s Contracture Without Surgery
Dupuytren’s disease -also known as Dupuytren’s Contracture – is a surprisingly common genetic condition, in which one or more fingers become stiff and bent if left untreated. Dupuytren’s Contracture is believed to affect up to 5% of all adults in the United States.
In the past, the only technique for treating Dupuytren’s Contracture was surgery – which many people wished to avoid. But, thanks to advancements in modern medicine, there is now a medication that can be injected into the hand to treat Dupuytren’s disease.
In this article renowned Detroit area hand surgeon Dr. Uzma Rehman discusses this condition, and explains how the relatively new injectable treatment for Dupuytren’s Contracture can help you avoid surgery.
What is Dupuytren’s Contracture?
Dupuytren’s Contracture causes the normally smooth sheet of tissue that lies underneath the skin of the palm and fingers to gradually become nodular and cordlike overtime. As this tissue stiffens and thickens, the fingers become increasingly bent, stiff and “contracted”.
The bend in the fingers caused by Dupuytren’s Contracture can become quite severe and interfere with mobility, impact motor skills, and compromise the ability to use the hand. Even easy day-to-day tasks can become impossible as Dupuytren’s Contracture progresses. Symptoms may include the inability to flatten the palm on a flat surface, being unable to shake hands or put on gloves, and even the inability to reach your hand into a pocket, purse, or container.
This disease most commonly affects the ring and small fingers, and can affect one or both hands. In addition to limiting use of the hand, Dupuytren’s Contracture also results in a noticeably “disfigured” appearance of the hand over time, which some people find embarrassing.
Diagnosing Dupuytren’s Contracture
Because Dupuytren’s Contracture condition develops slowly and has similar effects as arthritis or tendinitis, it is often misdiagnosed or mistaken for other conditions. But when the fingers become extremely bent enough treatment is usually required.
Macomb County hand specialist Dr. Rehman employs a comprehensive diagnostic approach to identify Dupuytren’s contracture through careful clinical examination and patient history evaluation. The diagnosis typically begins with a thorough physical examination where Dr. Rehman palpates the palm and fingers to identify the characteristic nodules and cord-like thickening of the palmar fascia that define this progressive condition. She assesses the degree of finger contracture by measuring the angle of flexion deformity and testing the patient’s ability to fully extend their fingers, particularly focusing on the ring and little fingers which are most commonly affected by Dupuytren’s contracture.
During the diagnostic process, Dr. Rehman also performs specific clinical tests including the tabletop test, where patients attempt to place their hand flat on a table surface, which helps determine the functional impact of the contracture on daily activities. Dr. Rehman also assesses for associated conditions such as Peyronie’s disease or plantar fibromatosis that can occur alongside Dupuytren’s contracture in some patients.
The diagnostic evaluation also includes discussion of risk factors such as age, gender, ethnicity, diabetes, alcohol consumption, and occupational factors that may contribute to the development or progression of Dupuytren’s contracture. Dr. Rehman’s expertise in hand conditions enables her to distinguish Dupuytren’s contracture from other conditions that may cause similar symptoms, such as trigger finger, arthritis, or tendon injuries, ensuring accurate diagnosis and appropriate treatment planning.
While imaging studies are rarely necessary for diagnosis, Dr. Rehman may occasionally use ultrasound to better visualize the extent of fascial involvement and plan treatment strategies for complex cases in her Macomb County practice.
Who is Most at Risk for Dupuytren’s Contracture?
Men are significantly more likely to develop Dupuytren’s contracture than women, with studies showing that males are affected at rates up to ten times higher than females. Age represents another crucial risk factor, as the condition typically develops in individuals over 50 years old, though it can occasionally appear in younger patients with strong genetic predisposition. People of Northern European descent, particularly those with Scandinavian, Scottish, or Irish ancestry, show dramatically higher rates of Dupuytren’s contracture compared to other ethnic groups, suggesting a strong genetic component to the condition’s development.
Several medical conditions and lifestyle factors can also increase an individual’s risk of developing Dupuytren’s contracture beyond the primary demographic risk factors. Diabetes significantly increases the likelihood of developing the condition, with diabetic patients showing higher rates of Dupuytren’s contracture and often experiencing more rapid progression of symptoms. Chronic alcohol consumption, smoking, and certain seizure medications have also been associated with increased risk of developing this hand condition.
Additionally, patients with a family history of Dupuytren’s contracture face substantially higher risk due to the hereditary nature of the condition, with some families showing multiple affected members across generations. Other associated conditions include Peyronie’s disease and plantar fibromatosis, which can occur alongside Dupuytren’s contracture in some patients, suggesting shared underlying mechanisms that predispose certain individuals to these fibrotic conditions.
Traditional Treatment for Dupuytren’s Contracture
Mild cases of Dupuytren’s contracture that do not have much effect on hand function may not require any treatment and can simply be monitored through regular checkups. But more severe cases may require treatment by a hand specialist.
For decades, surgery was the only option to treat Dupuytren’s Contracture. Surgical interventiom involves removing the diseased cords that are causing the finger(s) to contract. While surgery is usually very successful at eliminates Dupuytren’s contracture, recovery after the surgery may take 6 weeks to three or more months. Extensive physical therapy to regain use of the fingers and hand is also generally needed for a long period of time after surgery for Dupuytren’s disease.
Since any surgery comes with risks, and because the recovery period is quite extended, many people are reluctant to pursue surgical treatment for Dupuytren’s Contracture, and simply try to “learn to live with” this frustrating medical condition.
New Xiaflex for Dupuytren’s Contracture
The great news is that a relatively new medication called Xiaflex was approved by the FDA for non-surgically treating Dupuytren’s contracture in the last decade. Xiaflex is a medication, based in an enzyme base, that is injected into the diseased “cord(s)” in the affected area(s). Xiaflex “breaks down” the diseased tissue, which allows the finger to be easily straightened.
The day after the Xiaflex is injected, your hand doctor will administer a shot of local anesthetic into the area. Then she will manipulate the finger into a straight position and fit the finger with a splint. The splint typically only needs to be worn at bedtime for 4 months or less. You will also be given finger exercises to perform at home daily.
In clinical studies it has been shown that prescription XIAFLEX® medication is combined with finger extension procedure by a specialized hand doctor, it can straighten the affected finger(s) and improve range of motion after just 1 to 3 injections.
Since 2010, it is estimated that more than 150,000 patients with Dupuytren’s contracture have been successfully treated with Xiaflex!
Xiaflex for Dupuytren’s Contracture | Macomb County
If you or a loved one is struggling with Dupuytren’s disease, you do NOT have to suffer with stiff, bent fingers. Make an appointment with Macomb County hand specialist Dr. Uzma Rehman to discuss the benefits of exciting non-surgical Xiaflex treatment of Dupuytren’s Contracture – and see if this or another therapy is right for you.
Remember, the sooner you seek treatment the better chance you have of stopping or reversing the progress of this painful hand disease and the many inconveniences that come with it.
Dr. Rehman has helped hundreds of patients across Oakland and Macomb County start living a normal daily life again, with an incredible increase in hand mobility and function, thanks to new Xiaflex – without a trip surgery and without frequent trips to an occupational therapist.
