Injected collagenase enzyme digests Dupuytren’s tissue
An alternative to surgical treatment for Dupuytren's disease (see section on Dupuytren's contracture) has emerged over the last few years.
An enzyme is injected into the tight Dupuytren's cord in the palm. The enzyme digests small sections of the tissue, weakening the cord. At a subsequent clinic visit, a week or less after the injection, the contracted finger is stretched straight and the tight cord is ruptured. The stretching is done following a local anaesthetic injection. (see video)
In a typical case, no hand therapy is required and patients can return to normal activities directly. Sometimes the skin tears and there is a small wound which will require dressings for a couple of weeks. Sometimes hand therapy and a small finger splint may be helpful.
Xiapex works well for tight tissue in the palm. It is less predictable but can still be very effective for treating tightness in the finger which affects the middle knuckle (PIPJ).
Visit 1 - injection of Xiapex enzyme to hand - return to normal activities but expect some swelling and bruising and discomfort.
Visit 2 - (1-7 days after visit 1) injection of local anaesthetic to hand then stretching 'manipulation' of tight tissue (see video) - return to normal activities but expect some swelling and bruising. May sometimes require dressings and/or hand therapy.
"The little finger of my right hand had Dupuytrens contracture, which had been untreated for 20 years and the finger was bent forward to 60 degrees from vertical. Being right handed this made my dominant hand more difficult to use than I wanted it to be. The procedure took place over 48 hours with a visit for a relatively pain free injection of the Xiapex on a Monday and the straightening procedure two days later on the Wednesday. This was undertaken with a local anaesthetic which ensured that the pain level was negligible. It was very quick also and resulted in my finger returning to no more than 5 degrees bend away from normal. There was some bruising which lasted a few days and similarly when the anaesthetic wore off there was some aching for a few days, but nothing of great consequence. I was able to conduct an acupuncture treatment on the Friday though I didn’t go back to work fully till the Monday five days after the straightening." JC West London
Video of stretching ('manipulation') and rupturing dupuytrens tissue at Visit 2. This is 2 days after Xiapex injection and the manipulation is done after a local anesthetic injection.