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

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!



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?

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.



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?

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.




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?

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

Is the drug Xiaflex worth getting excited about as a Dupuytrens treatment?

I’ve been reading that Xiaflex (used for Dupuytren’s contracture) was tested for Peyronie’s disease with pretty successful results and could be on the market as early as this year. Should I get my hopes up? Is this worth being excited about?



I am hearing more and more about nasty side effects and bad reactions from Xiaflex injections for Dupuytren contracture.  I think this is – or should be – the reason that Xiaflex has not been given fast approval as a Peyronie’s treatment.  I have spoken to people whose muscles and tendons have been injured (dissolved by the enzymes in Xiaflex) and the many problems they have to deal with as a result of these injuries. 

From the tone of your email I get the sense that you are genuinely hopeful about Xiaflex might do for you, because you feel so helpless against Peyronie’s disease.  Most men feel this way. You can get your hopes up, and you can get excited about it, if you wish.  Many people are sitting around waiting for a medical miracle cure while their lives slip away with a curved penis or useless hands.  They have the attitude that if there is no drug to save them, there is nothing to help them because the body cannot do anything against Peyronies disease or Dupuytren contracture.  Personally, I do not accept that line of thought.  I have seen too many people injured by drugs, like Xiaflex, and helped by Alternative Medicine. 

I believe a far more rational and safe approach to treating these two problems, and many others, is to first attempt more conservative treatment using a wide variety of simultaneous Alternative Medicine treatment methods.   Only after exhausting all possible conservative options would I remotely consider taking the calculated risk of a drug like Xiaflex.   The tone of your question suggests to me that you are not aware of, or even considering, the possible harm that can be done with a drug like Xiaflex.  

Many new drugs come on the market each year because of glowing reports and spectacular enthusiasm for the wonderful research results.  The new drug is highly advertised and heavily used for a while.  Then slowly and quietly new information comes out that bad things are happening to those who take this new wonder drug.  Even more quietly the drug is removed from the market a year or two later.  How many times have you heard that same story played out over and over?  High hopes based on questionable research, people hurt, drug withdrawal, many lawsuits. 

Why do we see so many TV commercials from lawyers who are trying to sue the pants off these drug companies?   The legal profession has created this large industry for itself because there are so many bad drugs on the market and so many people who are injured, that lawyers can profit from this misfortune.  What should that tell you?  The lawyers are not making this stuff up.  They are just taking great advantage of the huge opportunity they are given by bad drugs and injured people. 

Fact:  The U.S. is the heaviest user of drugs and surgery.  Fact: The U.S. is ranked about the 16th healthiest nation in the world, and we die at an earlier age, behind 15 other countries that take fewer drugs and use less surgery than we do.  If the use of drugs and surgery leads to health and long life, we should live the longest and be the healthiest country and we are not.  What does that tell you?

Sure, there are good drugs and not all drugs are bad.  But you must be extremely careful how you go about using them.  Xiaflex might help you, I cannot say one way or the other.  In my opinion, if you are going to use Xiaflex it should be the very last thing you do, not the first thing.  You should certainly talk to your doctor about your decision and educate yourself to the best level you can. How you approach the treatment of your problem is your decision.  TRH