Tag Archives: xiaflex injection

My 25 year-old son has Dupuytren’s contracture. What treatment would you recommend?

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Hi Dr. Herazy,
I came across your website while searching for more information on Dupuytren Contracture. My son had intricate surgery on his finger in June and recently noticed a small lump on the palm of his hand. It’s not painful, but the doctor said it looked like Dupuytren Disease. He is only 25 years old and I am very concerned about the future. Have you seen this before in someone his age and can he stop the progression of this disease with your products? What treatment would you recommend for someone his age? There also may be a predisposition to this as I have a painful lump on the bottom of my foot that I will be checking out with a doctor. Thank you very much.
PG

 

Greetings PG,

You are a good parent.  Once a parent, always a parent.  My youngest one of three is soon to be 38, so I know how this goes.

My guess is that you have a genetic predisposition to this excessive fibrous tissue response that your son has inherited from you.  This is made even more so if both you and your husband/wife are also genetically predisposed with families coming from Northern Europe or Scandinavia.  If this is true it would explain why some one who is so young has developed this problem.  Perhaps your son has unknowingly made himself susceptible with other factors that increase the odds for Dupuytrens:  diabetes, cigarette smoking, alcoholism, and prolonged hand stress  like with manual labor.  I also notice that many serious musicians who play piano or guitar seem to develop DC more than the average population.  Any of these might explain this problem developing so early in his life. 

I have seen this before in people in their mid-20s and it is usually accompanied by factors as I have explored above.

I would recommend the largest and most aggressive treatment he can sustain for at least 3-4 months of faithful and diligent work.   If this problem is to respond at all to Alternative Medicine methods the treatment approach must be significant to make an impact on his condition.  Please read Can I treat Dupuytren’s contracture naturally without surgery or drugs?       Dupuytrens is a tough problem.  Half efforts are usually a waste of time.  Allow me to explain why I think someone such as your son should be extremely interested – far more than most all other people – in avoiding surgery and getting natural conservative treatment to increase his ability to eliminate his hand nodule.  

Hand surgery for Dupuytren’s contracture is not a cure; any good surgeon will tell you that needle aponeurotomy, palmar fasciectomy or Xiaflex injection are just a temporary measure; the Dupuytren’s contracture problem will always recur – it is a matter of when the recurrence will develop, not if.  When someone in his 60s or 70s develops DC and has surgery, the Dupuytren recurrence factor is not as important because frankly at that age this person might not live long enough to develop the recurrence and have it evolve over a few years to the point that a second surgery is important to them.  Many elderly people get their first DC surgery and just ride out the effects of the recurrence as they try to ignore a growing hand problem.  But with a 25 year old person all of this strategy is changed.

A young person has a lifetime to not only develop one recurrence of Dupuytren contracture, but several or many.   Some people can have a recurrence in just just 2-3-4 years and a few have recurrence in a year or less.  With each surgery recurrence usually is made to come more quickly; with each hand surgery the rate of recurrence increases.  It is as though the irritation and instability created by the surgery speeds up the recurrence phenomenon.    Many times after a few surgeries are done it does happen that eventually amputation is the only viable option that remains. 

With someone in his mid-20s this can be a great problem, since there are so many wonderful years that lay ahead.   For this reason it is my opinion your son should do absolutely everything possible to avoid entering upon this slippery slope.  I suggest that your son start as soon as possible to see if he can increase his natural ability to remove this foreign fibrous palm lump.  As with anything in healthcare (like Dupuytren’s hand surgery) there are no guarantees this will work, but when you consider the fact that his approach is without side effects, that in almost 11 years we have not had one report of recurrence after successful treatment, and that surgery can also be used at a later time if  necessary.

I suggest he does some reading on the DCI site to learn how this approach is done.  Let me know if you have any questions.  TRH

Any advice for other fingers after a bad Xiaflex procedure for the first finger?

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I just had the Xiaflex procedure done on my pinky finger and it was an extremely painful procedure I must say. The way it was done was that on the first day the doctor injected the Xiaflex at the base of my pinky finger. Within two hours the entire area was extremely swollen and painful. The following day the doctor did what he called “the manipulation” part of the procedure. I had the already extremely swollen and tender area of my pinky shot up with lidocaine injections which was very painful in and of itself. Then the doctor started wrenching the pinky back and forth so forcefully that I about passed out. He reluctantly injected more lidocaine (on my request) and came back 30 minutes later. He again wrenched the pinky so hard back and forth that I almost passed out, and had to sit with my head between my legs to keep from passing out when he was done. As a result of wrenching my pinky so hard I developed a large blood blister at the base of my pinky, which was extremely painful and took almost two weeks to finally go away. The area is still peeling skin and rather swollen and dark pink. Is this a typical procedure for Xiaflex? What I mean is it typical for this “manipulation” of an already tender and swollen finger? I am not feeling like I do not want to go through this again on other fingers which are crooked. Please advise!

 

Greetings,

A few thoughts come to mind based on what you related about your experience with the Xiaflex procedure for Dupuytren’s contracture:

1.  What your doctor called “the manipulation” is a standard part of the usual Xiaflex injection procedure in which the Dupuytren cord is manually broken or snapped in half after it has first been weakened by injection of the collagenase enzymes in Xiaflex.  It is how the procedure is done.  First the cord is weakened and the next day it is broken by forcefully bending and extending the involved finger.

2.  Based upon what you have described, I get the impression that the doctor who did your injection did not do a good job of injecting the enzyme into the cord to weaken it.  Either he did not inject enough of the enzyme into the cord, or he missed the target tissue.  Usually the procedure is not as abusive or painful as what you have described.

3.   Based on what you have described, I get the impression that your doctor did not adequately explain ahead of time what he was going to do or what you would experience.  This is unfortunate.  Without this information you could not make an informed decision about the procedure.

4.  I wonder if you are aware that after going through the painful and prolonged Xiaflex procedure that it is just a matter of time before your Dupuytren’s contracture will recur in that same finger.  Please read my post, “Do Xiaflex injections really have a low recurrence rate?”   In this post you can read about the Dupuytren finger contracture coming back over a period of time.   Based on the way you were not told about what might happen during the Xiaflex procedure I hope you were at least told that that the Dupuytren’s contracture will always come back after any surgical intervention, and yes, a Xiaflex injection is a surgical intervention.  If your doctor says it is not, ask him for a few bottles of Xiaflex to take home because you want to inject some Xiaflex in a neighbor’s hand.  Of course, he will not give any to you because you would be doing surgery and he cannot be a part of that.       

5.  I wonder how much experience your doctor had doing Xiaflex injections?

6.  I suggest that you spend some time on the DCI website to investigate the possibility of  using Alternative Medicine for a few months to see if you can support and increase your ability to remove the Dupuytren contracture material in a more conservative manner.   There is no easy way to get rid of Dupuytren’s contracture, as you have already seen after using the “miracle” procedure with Xiaflex.  Yes, it might get rid of the Dupuytren cord without surgery, but it has the potential for serious side effects and the benefits are only temporary.  I suggest you look into trying to rid yourself of the lumps and cords in your hands without risky surgery.  TRH

What do you think about my palm that split open after Xiaflex injections for Dupytren contracture?

Posted on by STL314

Two days after injection with Xiaflex for my Dupuytrens contracture, during the attempted release of the pinky and ring fingers on my right hand, the skin of the palm of my hand under those fingers split open, leaving a rather deep hole approximately 1.5″ square +/-.   I have been told it happened because of previous surgery some 40 years prior.  I have been told a skin graft might be advisable if the hole does not heal quickly on its own.

Your input would be appreciated.

 

Greetings,

Sorry to hear of the complication from Xiaflex hand surgery.   Your situation of the palm skin splitting open is not uncommon; it happens with some frequency although doctors tend not to discuss or warn patients about this complication.  I suspect this information is kept from patients so they will not refuse Xiaflex hand surgery.  

We both know I am not involved in the treatment of your hand and have no direct knowledge of your past or current condition.  I only know the very limited things about your Dupuytren surgery with Xiaflex injections you mentioned here.   Because of this limited information I can only ask questions:

1.   Was the doctor who did your Xiaflex injections aware you had prior hand surgery 40 years ago,  before he injected you with Xiaflex?

2.  Did you deliberately or intentionally hide this information about your previous hand surgery from the doctor, or did the doctor not ask you about the past hand surgery?  In other words, was the doctor aware of your hand surgery 40 years previously, or not, before the Xiaflex injection series was done?

3.   Since I assume you either told this doctor about the prior hand surgery, or hand scars were visible and there was no need to tell the doctor, did the doctor warn you ahead of time that this complication or adverse reaction might occur?  Was this possible complication mentioned to you, explained in detail, and were you allowed to give informed consent to refuse or accept hand surgery with this information from the doctor?   In other words,  did the doctor talk to you in detail about the potential for this kind of problem to occur so that you knew what you were getting into and had the chance to accept or refuse hand surgery?

4.   Did the doctor explain to you that there was a chance for the Xiaflex injection to leak out from the Dupuytren cord and migrate up to the skin of the palm, causing the skin to deteriorate and burst open?

5.   If the doctor knew, or should have known, about the potential problem of injecting your hand with Xiaflex since you had prior hand surgery, what did that doctor do differently while injecting your hand with Xiaflex to prevent this complication in your case?  

6.  Did the doctor who made the Xiaflex injection that resulted in your palm splitting open, explain to you how a surgery that was done 40 years ago was able to interfere with the Xiaflex injection procedure?  In other words, if your hand tissue was stable for 40 years, what was the underlying problem that caused the Xiaflex injection to go so terribly wrong?

7.  What is the possibility the doctor who provided your Xiaflex injections simply made a mistake – as is common and easy to do during this Xiaflex injection procedure – to cause this  tissue injury and subsequent spitting to occur?  What is the possibility the doctor who provided your Xiaflex injections is simply trying to protect himself/herself from possible litigation by blaming someone or something else for this problem?

There are many cases in which these problems arise after Xiaflex injections or other types of hand surgery.  They are usually played down because this information is not good for the Xiaflex manufacturer or the doctors who do the work in the office.   I think if patients knew of the high rate of these problems – and worse– occurring, they would far less willing to allow this procedure to be done.  In my opinion it is best to avoid Xiaflex injections if at all possible by using the Alternative Medicine procedures discussed on this website.   The body can possibly reverse the Dupuytren tissue when given the opportunity. You will only know if you try.

I suggest you do all you can to increase your ability to heal and repair the skin of your palm.  Your medical doctor will not know much about this topic.  He will not explain that he has never studied or considered this topic, he will only say it cannot be done.   I suggest you contact someone who is experienced and trained in health management like a naturopath or a medical doctor who specializes in natural medicine.   TRH

 

 

 

 

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

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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

Do Xiaflex injections carry a risk of reduced finger flexion?

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I have read after the Xiaflex injection to surgically treat Dupuytren’s contracture that moderate pressure is applied to ‘break’ the cord. Isn’t the cord a thickened tendon? In which case is there a risk of impaired flexion? Just wondered how precise is this breakage and if it would be possible to mistakenly break the tendon altogether. I would be very grateful if you could clarify this for me.

Yours sincerely

L. Al-Nufoury (med student)

 

Greetings L.,

The Dupuytren’s cord is not a tendon.  It is composed of tendon-like material and tissue elements, but it is not a normal or per-existing tendon of the hand.  Is a new structure that develops on top of the tendon, it is not normal for the hand and it is shorter than normal and so causes the affected finger to be flexed toward the palm.

This Dupuytren cord will break where  it is weakened by the fibrinolytic enzymes at the site of the Xiaflex injection.  Sometimes little and sometimes great force is needed to break the cord, depending on the size of the cord and the skill of the surgeon.

A significant limitation of this procedure is that the recurrence of another tendon developing again can be rather fast; Xiaflex injections have a faster rate of Dupuytren recurrence than open or closed surgery options.  For this reason the individual will have to be exposed to additional Xiaflex injections at a later time.  Another problem is that Xiaflex injections can lead to accidental and permanent damage to nearby muscles, tendons, nerves and blood vessels. 

The real risk of impaired finger flexion arises as a result of repeated Xiaflex procedures, when no more can be done since there is a limit to the number of times these injections can be delivered into the same area.    TRH