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