What is it?
The soft tissues in your hand and fingers are arranged in special layers. The layer just under your skin but above your tendons is called fascia. The fascia is in the hand to help bind the skin in place during grip. Without it the skin of the fingers would slide around during grip. It is normally a thin layer. In Dupuytren’s disease the fascia changes its behaviour. It gets thicker, forming lumps and cords in the palm and fingers. Any cords that form can shrink. This causes the fingers to be pulled over. If the fingers are left bent they can become permanently stiffened.
What causes it?
There is a strong family linkage to this disease but in most cases we do not know why people get this problem. Sometimes the cause can be traced to diabetes, liver disease smoking or alcohol intake. At present we do not think there is a link between Dupuytren’s disease and work. Dupuytren’s disease commonly gets worse over time. In some people it gets worse very quickly, in others it changes very little over the years.
How do you know that I have it?
An assessment in clinic is usually enough to tell you have Dupuytren’s disease. Special tests are not usually needed. Sometimes it is even possible to predict how severe your problem is from the history and examination alone.
Can Dupuytren’s disease be successfully treated without surgery?
Until recently no. However, it is now possible to treat some (but not all) patients with Dupuytren’s disease with an injection into the band of Dupuytren’s disease.
What is injected?
The substance injected is a type of chemical protein known as an enzyme. The chemical is called XIAPEX® (collagenase Clostridium histolyticum). It weakens the Dupuytren’s band allowing it to be disrupted (broken).
How is the injection performed?
The affected finger can be injected in the outpatient department when you see Mr Woodruff. Click on the link below to see a short video of Mr Woodruff using Xiapex to treat Dupuytren’s disease non operatively
Does the injection hurt?
Normally there is no more pain than a normal injection for a blood test or vaccination.
What happens after the injection?
Once the Dupuytren’s band has been weakened (one to three days after the injection), the involved finger is manipulated (straightened) by Mr Woodruff. Local anaesthesia may be an option during the finger straightening procedure.
Can my finger be treated?
Treatment with XIAPEX® is not recommended for all fingers affected by Dupuytren’s disease. In particular, it depends on which joint of the finger has been bent (contracted) by the Dupuytren’s disease. Mr Woodruff will be happy to discuss this with you but the pictures below may help to explain.
Picture 1a and 1b. The finger joint involved is the one nearest to the palm of the hand: suitable for treatment with XIAPEX®. Picture 1c shows the hand on day 14 post-manipulation
Picture 2a and 2b: The finger joint involved is the middle joint in the finger: not suitable for treatment with XIAPEX®
XIAPEX® is not recommended in children under the age of 18 years, pregnancy, or in patients who have received certain antibiotics (tetracycline) within 14 days prior to receiving an injection.
XIAPEX® must be used with caution in patients with coagulation (bleeding) disorders. For patients taking anticoagulants (blood thinning tablets), these must be stopped (with the exception of those taking Aspirin up to 150mg daily), 7 days prior to receiving an injection of XIAPEX®.
XIAPEX® is contraindicated in patients with previous hypersensitivity to collagenase and/or XIAPEX®.
Are there any side effects of the treatment?
There are some common local side effects that may be experienced after the injection and/or the finger straightening procedure. The most common of these are local swelling, bruising and pain around the injection site of the treated hand. These side effects do not necessarily indicate an unsuccessful procedure or any permanent injury to the hand and most of them resolve within two weeks. Sometimes you are advised to rest the finger in a splint as this may help the pain and swelling to settle down. Mr Woodruff will advise you on this.
Occasionally during the finger straightening procedure, some patients may experience skin tearing as the Dupuytren’s band breaks. If this occurs, standard wound care is administered.
Serious side effects, such as tendon and nerve injury, can occur but are very rare. Mr Woodruff will be happy to discuss this with you.
How long do the benefits of treatment last?
It is important to mention that, even with successful disruption of a treated Dupuytren’s band, there can be a recurrence of the finger contracture. However, in a recent trial no significant contractures recurred up to 12 months after treatment was completed.
Can the treatment be repeated?
Yes. In some cases satisfactory results can be achieved after just one injection. However, in other instances more than one treatment (injection and finger manipulation) may be required. Up to a maximum of 3 injections can be performed to the same finger at 4 weekly intervals. Mr Woodruff can discuss this with you.
Can more than one finger be injected at the same time?
No. Treatment is only recommended for one finger at a time. Mr Woodruff can discuss this with you.
How successful is the treatment?
Treatment with injections helps in approximately 65 to 75 percent of patients but it depends on how severe the finger contracture is. Mr Woodruff can discuss this with you.