Dupuytren's Contracture Injection Recovery Instructions

Dr. James Verheyden, Hand and Upper Extremity Orthopedic Surgeon, explains how to recover from Xiaflex injections for Dupuytren's Contracture.
For pain, take Tylenol 650 mg 3-4 hours after the injection and manipulation days and then, if you can take NSAIDS, alternate 650 mg of Tylenol with Ibuprofen or another NSAID every 3-4 hours for a couple days.
No ice for 6 hours after the collagenase injection as the enzyme is temperature-dependent. The enzyme stops working after 6 hours. After 6 hours, begin using ice, strict elevation, and finger range of motion exercises for swelling and pain.
Expect swelling, bruising, and tenderness in the hand. Skin splits are common after the manipulation procedure. It is hard to go from a severely contracted finger to a completely straight finger, and not have your skin split open. The wounds sometimes look very large and shocking but these wounds heal. Soak the hand in warm water with Epsom salts.
Many times skin splits are beneficial as they make it easier and quicker to get the fluid and swelling out of your fingers and the wound heals with new, non-diseased skin.
Stretches
#1: Massage the palm and fingers to desensitize the nerves and help with swelling/edema. You can be quite firm with massaging
#2: Take your opposite hand and squeeze your fingers all the way into a ball.
#3: Take your opposite index finger and bend your wrist, bend your finger at the MCP joint. Make what I call is the “letter C” and then reach under your finger and fully extend at the PIP joint.
This will push out all the fluid, swelling, and blood in your finger and hand, greatly accelerating your rehab. Do these stretches for 1 minute total, every hour that you are awake for at least the first 2 weeks.
Wear the splint just at night, every night for the first 2 weeks. Do not wear the splint during the day. It is more important to stretch and keep manipulating your fingers.

[@mikep.4809]

Not to bad mouth or be disrespectful, I have Severe Dupuytrens on both hands and feet as well. This enzyme is or was $3,000.00 per shot unless you have Blue Cross and an amazing prescription plan. I had done and it Definitely worked. And the sound it made when the doctor opened my hand was gross! Sounded like a bag of potato chips being crushed. It came back within 6 months and I didn't want to do it again. I have since then found an amazing plastic surgeon who specializes in hands. Yes, it's surgery and yes there's a ton of stitches but it takes the same amount of time for recovery. I had surgery on my hand, was sent home with it all wrapped up and a half cast from my wrist to my fingers so not to bend my fingers. I had a sling and was told to keep it in the sling for 4 days. I'm not very good at being confined to only 1 arm so I stopped using the sling the next day. That's on me, my decision and I'm not saying you should do as I did. Anyway, yes it sucks having to wear a bag on my arm in the shower and you can't really hold a hamburger but it's only 2 weeks. My stitches come out in 3 more days. 55 by the way... but this is my 3rd time and it heals really fast. My disease is very advanced so I may have to go thru this every 5 to 10 years but in my opinion, the results are better. I was as honest and forthcoming as I could be and hope this helps.

[@thecenteroregon]

Glad to hear you are happy with the surgical results. Dupuytren's has a 50% recurrence rate, regardless of treatment by surgical or nonsurgical options. It's important to work with your physician to fully understand the treatment options and risks/benefits. Typically a nonsurgical option is presented first because it is less invasive and many patients regain the full function of their hand after treatment. Thanks for sharing your experience!

[@NightBazaar]

For me, the quote I got was about the same, $3000 per enzyme vial. Insurance, at the time, wouldn't cover it because it was too new of a procedure. The doctor told me I'd need 2 or 3 vials. I asked him how many patients he's performed the procedure on. He said 3. I decided against having it done.

[@niloc1973]

Interesting. I have the same. How much was the surgery?

[@TreuNorthExplorers]

I jammed my pinky finger when I was 21 years old playing basketball. Diagnosed with Dupytrens when I was 23 with contracture. I've had two surgeries since then. The contracture came back after the first surgery within 1 year. The second surgery (age 31) included a skin graft and the contracture came back within 4 months after surgery. Considering Xiaflex but not sure how it will work with the skin graft on the middle of the pinky. (Never smoked, never consumed alcohol, never drink caffeinated drinks, very active and other than this disease, healthy)

[@thecenteroregon]

Dupuytren's is a disease and has a 50% recurrence rate, whether treated surgically or non-surgically. An orthopedic hand surgeon would need to evaluate your hand to see if you are a candidate for Xiaflex after surgery.

[@scoobiedew82]

Thank you. That was helpful.

[@leesahughes1192]

July 12/2023 I had my injections yesterday my Dr didn’t say anything about keeping my hand elevated he didn’t tel me anything he didn’t numb my hand either before giving my injections he said it didn’t hurt would feel like a TB skin test. I have to say I’ve had 2 TB skin tests and they didn’t hurt at all and those injections really hurt but I never let on to him. This Dr has no bedside manner. I go back today for the second part a bet he doesn’t numb it up I’m dreading it. I know it’s going to hurt.

[@kudmondx1829]

How did it end up going ?

[@michaelherron4306]

I like to try this over surgery but they don’t offer it in Europe. They used to but those enzymes were taken off the market here. I’m not exactly sure why but I think it was related to efficacy and side effects…

[@chinomalon]

I have a big hard Dupuytren nodule at the base of right pinky finger. If the needle gets injected there, is there a risk the enzime may dissolve and break the tendon underneath and then i would not be able to close that finger?

[@vilorijaspasevski1106]

Molim Vas prevedite na srpski,obostrano imam kontrakture

[@garykrempien7038]

The hand specialist I saw would not have anything to do with this. So I opted for the surgery. Now I have so much scar tissue in my palm it's like having a leather glove on all the time. Loss of dexterity, can't hardly write my name anymore. Now in my early '70's, nothing more can be done.

[@thecenteroregon]

Unfortunately a lot of hand surgeons only consider the surgical option. We are sorry to hear about your outcome.

[@kudmondx1829]

What about a skin graft?

[@JuanitaCathey]

Dang bro life goes on take care

[@froggy0162]

How do feel about shipping some of this to Australia…? The manufacturer has decided to stop selling it here!

[@normveronicagenier7402]

Can it be done in a severe case

[@thecenteroregon]

Yes! You can find a specialist on the website below, however the technique shown in this video is exclusive to our practice. dupuytrens-contracture.xiaflex.com/patient/about-xiaflex/

[@williamb8091]

I have two nodules on each of my palms under the pinky fingers. I've noticed the nodules progressing for about two years. I worry about how much time I have left before it progresses to a contracture. I'm 28 years old and male. If there are any preventative measures I can take I'd love to hear them. Are smoking and drinking really factors. I don't drink but I do smoke cigars often. Thanks for the video.

[@LuxuryZoneProductions]

I have it in 7 fingers

[@LuxuryZoneProductions]

Try not to get the open surgery. It spread to 3 other fingers shortly after my surgery

[@williamb8091]

@@LuxuryZoneProductions Thank you. I appreciate the feedback. Sorry to hear about the spread, man.

[@LuxuryZoneProductions]

@@williamb8091 no problem. U take care

[@plumbtblue]

I've had it in my left hand for about 10 years now. it started as yours has. My gut feeling is it started from doing guitar bar chords, using a lot of pressure on my pinky. I have always stretched my fingers back in an attempted to slow it and i think it's worked a little. My pinky and ring finger can't go straight anymore and my pinky knuckle is being pushed out. It's a hereditary and may skip generations.

[@donna_s_phillips7712]

Is this available in Australia?

[@hail2121]

I have this at 19 but it's just like more of a tough ball of lump the size of a marble but my hand is fully functional it just has this and I'm mixed race with a white mother and african american father, can someone help me know if i need to get it checked or anything or if its even Dupuytren's contracture?

[@thecenteroregon]

You should see a hand specialist for proper diagnosis of a lump in your hand. If it is Dupuytren's it may not need treatment right away if your hand is still fully functional.

[@tulllguy]

nice Dr.

[@mrp3930]

docs in uk won't touch my hand or send me to a specialist, can't put my hand flat on the table. I get pain in my hand also. I have asked numerous times about treatment but they won't do anything......USELESS !!!!

[@Campsnowcactus]

Sorry. Had it done on left little finger, never worked. Don't waste your money.

[@cbryce9243]

When I went to the doc for treatment, he gave me numbing, but didn't give it even 20 seconds to work and stabbed me hard with the medicine. It was so painful I started slapping the table with my other hand. Boy was I mad! I never want to go back and get an injection again! You sound like a nice doctor. It's come back, if I am ever desperate enough to go get something done for it again, I will be more careful about who I pick. Thank you for sharing.

[@NightBazaar]

I was considering this treatment a good number of years ago, and went in for a consultation. The doctor said I would need to return the next day after the enzyme injection to stretch the fingers in order to break the cords. He said it would be painful. I asked if he would numb it up first before breaking the cords, and he said no. That was all I needed to know to decide to forget about the treatment and just live with the fingers as they are.

[@englishcakewalk8332]

Mike, You are like godsend! I am 75 years old with stage 2 Dupuytren's Contracture..it began as a nodule near the base of my right pinky 2 years ago..

[@glennjohnston7115]

My doctor told me I was immune to this! It quit working

[@artsarkisyan4095]

if i dont have contracture yet, would this be beneficial at early stages and maybe use graston technique to work out the fibrous fascia before it turns to a contraction

[@thecenteroregon]

Our physicians typically recommend the procedure when you can no longer place your hand flat on a table to break up the contraction, not as a preventative measure.

[@JuanitaCathey]

The amount of trauma

[@plumbtblue]

How is the enzyme attacking the affected facia and not damaging the surrounding nerves, tendons, etc?

[@thecenteroregon]

You can research more information about how the enzyme works by visiting the Xiaflex website, dupuytrens-contracture.xiaflex.com/patient/

[@pmroveda]

We are in New Jersey. Do you know someone with your expertise in this state. My husband had a massive stroke 5 years ago, and still has “stiff, locked fingers” on his left side.

[@thecenteroregon]

Hi, Dr. Verheyden uses an "off label" technique for the collagenase injections and has done extensive research to be able to provide the most effective results for his patients. We don't know of any providers that do the procedure the same way. However, here is a link to providers that treat Dupuytren's with Xiaflex: dupuytrens-contracture.xiaflex.com/patient/specialist-locator/

[@CarolMoore-k2k]

WHERE IS this doctor located?

[@brendareed5050]

Does insurance cover this procedure?

[@thecenteroregon]

Many health plans and Medicare cover this procedure, contact your specific health plan to find out what they cover.

[@MotownRockinroller]

If you have Medicare, it will cover 80% of the "street value" of Xiaflex. The last I read, its street value was around $5500 for one vial. So your share of the copay could easily be into the 4 figures.

[@annakalminskaia9610]

Most do

[@calimero6356]

I was asking for Xiaflex here in France, but they didn't give me that option. Is there any other European country opened to Xiaflex?

[@gustlfaller4494]

Unfortunately it is not your government, but the pharma company Pfizer, which does not market this medicine in all Europe, including the Scandinavian countries where Dupuytren's disease is very frequent. Pfizer made billions with their covid vaccine, so at least they could open Xiaflex for other medical companies. But no. Pfizer is not interested in the well being of people, only for the money.

[@50redz]

Where can igget this treatment in uk

[@TheMilesOG]

Would this procedure increase mobility for someone with a flexor tendon rupture at the FDP joint?

[@thecenteroregon]

Tendons can often be repaired surgically. Check with an orthopedic hand surgeon to see if there are other options for your injury.

[@SantoshKumar-lg4oz]

हिन्दी भाषा में बताने की कृपा करें 🙏

[@robertlinn]

Sounds difficult and arduous

[@thecenteroregon]

Many patients prefer this over surgery, but it isn't for everyone.

[@karenkirwan1280]

I saw Dr Charles Day at Henry Ford and he told me I'm not a candidate for injection. He's got super credentials but I'm not convinced.

[@thecenteroregon]

Our practice is located in Bend, Oregon. We can sometimes do telehealth visits if you would like to do a consult or get a second opinion for your condition.

[@wstagner]

i encourage you to get a second opinion

[@karenkirwan1280]

@@wstagner I'm definitely getting a second opinion.

[@brendareed5050]

In your experience approximately how long before the enzyme injections would need to be done again? How can I find a doc who does this procedure in Northern California? Thank you.

[@thecenteroregon]

Sometimes the disease comes back after the injection (or any procedure) and sometimes it doesn't. It's impossible to know when or if that will occur. You can find a specialist at this website, however this off label technique is exclusive to our practice. dupuytrens-contracture.xiaflex.com/patient/about-xiaflex/

[@sigmareite]

I had surgery done on my my right pinky finger in San Francisco, since that is where I live. Blue Cross. The hospital on Castro Street

[@captainchedo3592]

What is the cancer rate after injection ?

[@thecenteroregon]

You can read about all potential side effects of Xiaflex on their website: dupuytrens-contracture.xiaflex.com/patient/

[@tammybushnell6920]

Can you have radiotherapy afterwards to prevent recurrence?

[@thecenteroregon]

Dupuytren's is a disease, so it can come back after any procedure, even surgery.

[@melissapittmanfischer8064]

Should I treat a skin split with neosporin and bandaid?

[@thecenteroregon]

Dr. Verheyden recommends to cover the split with Xeroform (yellow petroleum non-adherent) and a soft dressing. You can also soak the hand in warm water and a teaspoon of Epsom salt the day after manipulation, twice a day for 5-10 minutes.

[@melissapittmanfischer8064]

@@thecenteroregon Thank you! That is very helpful and way more info than my doctor gave me.

[@joelpirela]

I suffer from Dupuy's and one hand is blasted the other is starting to go. As a member of a gang, it's very important to have mobility on all fingers as a curled or straight pinky in a hand signal may be the difference between getting shot or getting a beer. I'll ask my dealer about xiaflez. peace.