Could Xiaflex injection for Dupuytrens cause a side effect or bad reaction in my low back?

Hello Dr. Herazy,

I had one Xiaflex injection for my hand on a Wednesday, and had most of the normal reactions. Swelling in hand began to subside on following Monday. I had a large bruise about 2″ wide inside same arm that went from elbow to shoulder-very dark purple, then yellow, now gone (about 1 week total). My wrist on same side also showed bruise about 3″ square area.

Worst of all, I had an extreme back issue in an area where I have degenerative disc disease (L-4). I have lived with back episodes since age 15, now age 64. I have never experienced this extreme back pain, was taken to hospital via ambulance, when pain became so strong I could not move. I did help pick up a piece of steel on Monday, nothing unusual or extreme, then I had usual sore back until Wednesday AM, when I awoke and could barely get out of bed. I had to go to the floor, then work my way onto my feet.  I could not turn, lean forward or backward or twist, lift anything.  Tried ice pack, double dose Tylenol 3 with codeine, and Biofreeze. Finally became totally immobilized due to intense pain, called 911, went to ER, several muscle relievers and pain shots, came home and am taking medication now. In my adult life, I have never experienced anything near this intense. I wonder if the Xiaflex softened/weakened the tissue between the disc in my back enough to cause this problem.

I would like to hear if other chronic back patients who suffer milder problems same as I do every six months or so had an extreme reaction. Are there others with chronic bone/nerve connectivity issues who also had extreme occurring?

It seems plausible because of the reaction up my arm that the drug also could be carried into other parts of the body, weakening tissue.

Thanks.

 

Greetings,

I have explored this topic at some length for you.  While there is some small suggestion that Xiaflex might migrate from the primary area where it is injected, the research – at this time – says that it would be stopped at the lymph nodes.  In the case of Xiaflex treatment for a Dupuytren hand problem, this would mean it would probably go no further than the lymph nodes in the armpit. There is no current report of Xiaflex traveling throughout the body, as you suggest.

It would seem that the most likely explanation is that your extreme low back pain flareup was not much more than a coincidence.    TRH

Use Dupuytren Hand Contracture Caliper to measure bent fingers

Successful Dupuytren treatment demands that you know the exact limit of your hand contraction each step of the way

The Dupuytren Hand Contracture Caliper is a requirement for good results with self-directed Dupuytren treatment.  You must know how much your hand is contracted and finger movement is limited in order to guide your therapy plan to a successful conclusion.  Otherwise you are only guessing about your hand contracture, and that does not help you regain full use of your hand.

People are wrong to only pay attention to the obvious palm lumps and finger cords of their Dupuytrens contracture.  The Dupuytren Hand Contracture Caliper makes it easy to know exactly how much their finger contracture is affecting hand movement and flexibility.

Dupuytren Contracture Institute Calipers to measure hand contracture and bent fingers

DCI caliper is an essential tool to guide Dupuytren treatment

The DCI caliper with built-in measurement scale will help you easily and accurately determine reduced finger and hand movement caused by Dupuytrens disease. With it you will document how far your finger contraction is kept flexed toward the palm or wrist, as well as the other important measurement of how far your palm is kept from flattening against a table top or other flat surface.  These two numbers are essential baseline measurements to determine progress, or lack of progress, of your self-directed Alternative Medicine Dupuytrens treatment.

If you do not know the true state of your bent finger and hand contracture at the start of care you will never know exactly how much improvement you have made, or if you have made any at all.  You must know if you are making actual progress over your Dupuytren hand problem because this information will tell you if and when to change your treatment or perhaps not change it at all.

Many people think, “I’m not stupid. I will know if my finger is improving.  I do not need to measure.”  But they find after a few weeks of treatment they are totally unsure if the progress they think they have made is real or just a hopeful product of their imagination.  Armed with this valuable information you will know if and when to change a treatment plan that is not working, or to keep following a treatment plan that it is working.  Either way, for best treatment results you must not guess about any of this.

Order Dupuytren Hand Contracture Caliper  

Using the DCI caliper to measure contracture of the hand:

  1. The caliper is tightened or loosened by using the large plastic knob at the pivot in the middle. The caliper has two pairs of “legs.”  The “inside legs” are used to measure the inner distance of a closed surface, and the “outside legs” are used to measure an outside surface.  The inside legs of the caliper are straight but bent only at the very tips to look like the letters “J” and “L.”   The outside legs are rounded to look like big pincers or the letter “C.”   To measure with either the inner or outer legs the caliper must be positioned so the straight legs are crossed over each other and the curved millimeter (mm) scale to provide a distance reading, just as you see it in the picture, above.
  2. Adjust the large plastic knob in the center of the caliper so the legs move with moderate resistance; this assures your measurements are accurate.  The knob must be loose enough that the legs move with some ease, but tight enough that they do not move once you put them in position.
  3. Each line on the curved scale represents 2 millimeters (mm).  The scale ranges from 0 to 200mm.
  4. Position the tips of the straight inside legs so the “J” and “L” touch each other. Notice that the edge of the moveable leg touches the “O” on the mm scale, meaning no millimeters. When the tips of the inner legs are 50mm apart the tips of the outer legs are also 50mm apart.
  5. Either half of the caliper – the “inside legs” or the “outside legs” – can be used to document improvement of your limited finger and hand movement.  Use either side or pair of legs that is more comfortable or whichever one works best for your circumstance since the measurement will be the same.

Marking hand and fingers for measurement

Each time the hand is measured the same pair of reference points must be used, and the information must be written down for later comparison using the “Caliper Hand Measurement Chart” you received with your DCI Hand Caliper.

It is best to use naturally occurring landmarks on the fingers, palm or wrist of your hands if they are small enough to make a precise measurement, and if you will be able to easily find the same landmark each time you use the caliper for hand and finger measurements.

Locate a small and easily recognized natural landmark on the involved finger and hand.  These two points should be obvious and easily located each time you measure your progress. Carefully place a dot precisely at the point you wish to use each time you measure. Using large dots or different point locations make inaccurate readings that cannot be compared over time, and this does not help you to know if you are progressing or not.

  1. When taking measurements for the first time write notes or make a quick drawing of the local area that explains each point location in a way that is easy for you to understand and duplicate.  For easy reference, write the notes that describe the points you are using on your “Caliper Hand Measurement Chart.
  2. Mark you skin with a fine felt tip or ballpoint pen to clearly identify the exact points you will use each time to make your measurements.
  3. Examples of natural landmarks on your fingers, hands or wrists that will increase the speed and accuracy of your measurements:
    a. Where a fingernail has a natural vertical ridge or flaw that does not change.
    b. Where the fingernail bed and skin touch at the end of the finger (that little corner location where you might sometime get a hang nail).  Use the same fingernail corner each time.
Find a good point for measurement of contracture of hand by using the corner of the nail bed when the hand won't open.

Figure 1. Either corner of nail bed can be used to make caliper measurement.

Dupuytren disease measurement to determine progress of Dupuytren treatment involves measuring distance of finger contraction from wrist or palm.

Figure 2. Either corner of nail bed can be used to make caliper measurement.

 

 

 

 

 

 

 

 

 

 


 

 

c.   The very tip of your finger; it is the highest point when you look at your finger from the front and from the side view.

Treatment of Dupuytren's contracture progress is measured using measurement to determine how each bent finger is kept flexed toward palm.

Figure 3. Center of finger looking from side view.

Measure center of contracted finger that results in bent finger and hand that won't open

Figure 4. Center of finger looking from front view.

 

 

 

 

 

 

 

 

 

 

 

 

Little fnger tip showing center of contracted finger because of Dupuytren cord and lump on palm of hand.

Figure 5. Center of same finger shown in Figures 3 & 4, found by combining information from front and side view

 

 

 

 

 

 

 

 

 

 

 

 

 

d.   At the base of your palm, on or near the wrist crease, find a point where two or three creases meet to form a “V,” “X” or “Y”.

Wrist crease is good reference point to determine how far bent fingers how far hand contracture is held.

Figure 6. Look closely for naturally occurring "Y" formation created by creases as base of palm of hand

Measurement at a palm reference point monitors progress of hand contraction and ent fingers

Figure 7. Two creases cross at this point making a very clear "X" to be used as a reference point for measurement.

 

 

 

 

 

 

 

 

 

 

 

 

 

Life is difficult for those with Dupuytren's contracture when the hand won't open and finger contraction makes common daily activities impossible.

Figure 8. An inverted "Y" can be used to measure Dupuytren treatment progress.

Dupuytren disease causes reduced hand dexerity due to contracted fingers and palm lumps.

Figure 9. Here is a good reference point. a "V" that touches the natural wrist crease

 

 

 

 

 

 

 

 

 

Dupuytren contracture treatment progress can be monitored by measuring changes of hand contracture and how badly bent fingers are flexed toward lumps on palms.

Figure 10. Place ONE dot where lines cross or meet to form an "X" or "Y" or "V" landmark on or near wrist cease.

 

 

 

 

 

 

 

 

 

  1. Slightly bend your wrist.  Notice if one or two wrist creases create a nice landmark that will be easy to locate each time you want to measure your progress.   A crease or wrinkle of skin may cross over a vein, tendon, scar or blemish, making a precise reference point.
Dupuytren's contracture of hand and loss of finger dexterity result in a hand taht won't open.

Figure 11. Here a vein crosses under the wrist cease, making an excellent natural landmark for measurement.

 

 

 

 

 

 

 

 

 

 

 

 

 

If all else fails you can locate the center of the wrist crease using a ruler, although this is much more difficult and less precise.

Order Dupuytren Hand Contracture Caliper 

Measure distance bent finger flexed toward palm

Each time you how close your finger is kept flexed toward your palm you must use the same two reference points on the finger and palm or wrist.  If you have Dupuytren contracture of one finger you will use two reference points.  If two fingers are flexed toward the palm of one hand, three reference points are needed (one on each finger tip and a single point on the wrist).  Three fingers require four points for measurement.  You will make a mark on the fingertip of each involved finger and you will use the same point on the palm or wrist as a reference point for each finger.

  1. Mark each involved finger – Find a natural landmark or locate the center of the fingertip, as described above, of each finger affected by Dupuytren contracture.  Place a small precise mark at each point.
  2. Mark the palm or wrist – Find a natural landmark or measure for the center of the wrist crease, as described above. This wrist point does not have to be in direct line with the involved finger(s); it can be off to an angle or side of the wrist.  The only rule is that you use these same points each time you measure.
  3. Less contracture of hand and fewer Dupuytren cords allows bent fingers greater movement.

    Figure 12. DCI hand caliper is used to measure two simple and exact reference points, guiding Dupuytren treatment to successful conclusion.

 

 

 

 

 

 

 

 

 

 

 

 

 

a.  The wrist point can be located on the palm-side at the center of the wrist, or at an angle off toward the thumb or little finger side of the wrist crease; it can be anywhere on the crease as long as it easy to locate accurately and can be duplicated each time a measurement is made.
b.   If two or more fingers are involved on the same hand, the same palm or wrist point is used as the reference point for all fingers of that hand.
c.   Open your hand as far as possible.
d.   Place the tips of two caliper points (either inner or outer legs) on the small dots you selected at the finger and wrist points.

Keep exact records of how far finger contraction causes bent fingers to reduce hand use.

Figure 13. Place tips of two outside legs on the finger and wrist point to determine the distance the finger is kept flexed toward the palm.

It is important to have an exact measurement at the start of Dupuytrens treatment to document how far each finger is contracted and how far hand won't open.

Figure 14. This measurement is taken from the corner of the nail bed to a naturally occurring point at or near the wrist crease. Either finger point (center point of finger or corner of nail bed) can be used, but once a particular set of points are used at the start of treatment they cannot be changed without upsetting the accuracy and relevance of the progress your measurements are intended to document.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e.  Write the millimeter (mm) distance, as shown on the curved caliper scale, on your measurement record.

 

Measure amount of hand contracture

Each time you measurement your inability to flatten your hand on a tabletop, you must use the same two reference points.

If you find that only one side of the hand is kept from flattening out, and the other can be made flat, then you need to only measure the side that cannot be flattened. If both sides are kept from flattening, then you should measure both the little finger and index (pointing) finger side of the hand.

  1. Locate a deep wrinkle or crease that is near the knuckle that cannot be flattened.  Place a small dot at the end of the selected crease or wrinkle to serve as the landmark or reference point for that joint.
  2. Mark the side of the finger joint or knuckle that cannot be flattened against the table top. The 1st point can be anywhere on the side of the knuckle that is a naturally occurring landmark; it does not have to be in the center of the joint.

 

Treatment of Dupuytren contracture progress can be measured to note reduction of hand contracture and bent fingers that are less flexed by Dupuytrens cords and palm lumps.

Figure 15. The side of the flexed knuckle joint will have deep creases or folds that can be used as reference points to measure inability to flatten hand.

Treatment of Dupuytren's contracture progress is measured using measurement to determine how each bent finger is kept flexed toward palm.

Figure 16. The end of this crease makes a good reference point for measuring how far the palm is kept flexed and unable to be flattened against a tabletop. This is the classic test for Dupuytrens contracture.

 

 

 

 

 

 

 

 

Locate and mark a natural reference point to measure contracture of hand movement.

Figure 17. Locate the top or bottom end of a natural crease on the side of the hand that won't open.

Dupuytren contracture measurement must be done to guide Dupuytren treatment by measuring distance finger contraction prevents hand from opening fully.

Figure 18. The top or bottom of any deep crease can be used to make this measurement of hand contracture.

 

 

 

 

 

 

 

 

 

Dupuytrens contracture results in hand contracture and bent fingers caused by Dupuytrens cords and palm lumps.

Figure 19. Shows three possible points that could be used for this measurement. Place ONE dot at the end of a well defined crease on the side of the knuckle that cannot be flattened against a tabletop.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. The 2nd reference point in this measurement is the tabletop the hand is resting on, and therefore does not have to be marked.
  2. Place your hand on a table top or similar surface.  Press the hand down firmly so the palm is as flat as you can make it.
  3. Using one leg of the inside caliper (with the long straight legs), allow it to touch the dot on the side of the knuckle.
  4. Using the other leg, place the tip on the flat surface directly below the mark you placed on the knuckle being measured.  Do not place the tip of this leg at an angle or far from the knuckle being measured.  If you are not careful with this tabletop point selection you will add a variable to the measurement that will make comparison of other measurements invalid and inaccurate.
An essential part of Dupuytren treatment is exact measurement of hand contraction and finger contraction to assure progress is being made and guide correct therapy dosage.

Figure 20. Place the ends of the two outside legs on the knuckle point and the tabletop to determine the distance in millimeters the hand is kept from flexed so it cannot flatten against the table.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.  Write the millimeter (mm) distance, as shown on the curved caliper scale, on your measurement record.
6. To measure the distance the joint on the other side of the hand is being kept from flattening against the tabletop, repeat steps 2-7.

 

Order  Dupuytren Hand Contracture Caliper 

 

Keep accurate and detailed records of your changing finger contracture limitation so you can make appropriate increase or decrease of your therapy plan.

Figure 21. The complete DCI Hand Measurement Form, enables you to use accurate records of your progress to guide your treatment of Dupuytren contracture.

 

Success while using Alternative Medicine treatment for Dupuytren contracture requires that self-care be based closely on positive changes in the distance contracted fingers are kept flexed toward the palm.

Figure 22. Space to indicate if the measurement information being recorded is for the left or right hand.

 

 

 

 

 

 

 

 

 

 

 

 

 

This is the measurement form that comes supplied with the caliper to record increased finger and hand movement.  You will need good records because they are essential to know when to alter your Dupuytren treatment plan and how to do it.

The caliper can be used to determine how far the hand contracture prevents the hand being placed flat against a tabletop.  This informiaton is useful to know if and when to change Dupuytren treatment if progress is not being noted.

Figure 23. Space to record the date and millimeter distance the palm is kept from the tabletop, measured at the knuckle.

The caliper can be used to determine how far the hand contracture prevents the hand being placed flat against a tabletop.  This informiaton is useful to know if and when to change Dupuytren treatment if progress is not being noted.

Figure 24. Space to record the date and millimeter distance the each involved finger is kept flexed toward the palm. Note that records for more than one finger measurement

 

 

 

 

 

 

 

 

 

 

 

 

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