Non-Surgical Treatment for Dupuytren’s Disease Recently Approved by the FDA Offered by Dr. John T. Knight

On February 2, 2010, the Food and Drug Administration (FDA) approved the first non-surgical treatment for Dupuytren’s Disease that uses Xiaflex ™(collagenase clostridium histolyticum) as the first drug to treat this progressive hand disease which can affect a person’s ability to straighten and properly use their fingers.

Dr. John T. Knight, a board certified orthopaedic surgeon specializing in minimally invasive procedures for the hand, wrist and upper extremity is the director of the Hand and Wrist Institute. is pleased to offer his patients this innovative treatment. With more than 20 years of experience, Dr. Knight continues to be at the forefront of treatment plans to provide relief for his patients in the least invasive manner possible in an effort to bring life back to their hands.

“The approval of Xiaflex by the FDA with such strong support is a very exciting development in the treatment of this debilitating disease that has such a dramatic impact on the lives of my patients,” said Dr. Knight. “Surgery for this condition is painful and has a long recovery time. I expect over time this will become the standard of care for this disease offering a much more viable alternative to the traditional surgical approach. I am very excited to be able to offer this ground-breaking treatment to my patients.”

Overview Dupuytren’s Disease
Dupuytren’s (pronounced “DOO puh trenz”) disease is a naturally progressive hand condition that affects the layer of tissue just under the skin of the palm. As it progresses, it can have an increasing impact on how you use your hand.
In early Dupuytren’s disease stages, lumps (or nodules) and dimples may appear in the palm. During these stages, the disease may have minimal impact on your daily activities.

As the disease progresses, rope-like cords may appear under the skin of the palm, causing one or more fingers to permanently bend toward the palm. This could prevent you from straightening your finger and interfere with your ability to do everyday tasks.

Cords and Contracture
The bend in your finger results from excess collagen build-up that causes the tissue under the skin of the palm to thicken and become similar to scar tissue. (Collagen is a protein that is normally part of many tissues in the body.) As the disease progresses, a rope-like cord may develop under the skin that extends from the palm into the finger. Cords are considered palpable if they can be felt when the skin is pressed.

The bend in your finger joint caused by the cord can be measured in degrees. You may hear this referred to as “degree of contracture.” This cord may gradually tighten and pull the finger permanently towards the palm. The bend in the finger is often referred to as contracture.

Disease Progression
The signs of Dupuytren’s disease can change over time, sometimes over a period of years. How severe the disease becomes and how quickly it progresses can vary from patient to patient. Dupuytren’s disease initially affects one finger. It usually starts with a bend in one joint — often the joint at the base of the finger — but may eventually affect other joints on the same finger. As the disease progresses and the cord continues to tighten, the amount of bend increases.

For most people with Dupuytren’s disease, the ring finger or the little finger is affected. While the middle finger may be affected, the index finger and thumb are rarely involved. For some people, Dupuytren’s disease can develop in multiple fingers and may affect both hands.

XIAFLEX™ is the only FDA-approved Nnonsurgical Treatment for Dupuytren’s Contracture

Treatment Options
There is no cure for Dupuytren’s disease. Surgical and nonsurgical treatments focus on improving the disease’s signs and symptoms. Only a clinical examination and discussion with a qualified physician can determine the most appropriate treatment option for you.
Surgical Treatment. Several types of surgery may effectively treat Dupuytren’s disease. Surgical procedures differ on characteristics like how much tissue is removed, the type of incision, and the length of recovery.

The most common surgical procedure is fasciectomy, which removes diseased tissue and may have a large incision. Other procedures include fasciotomy, which involves surgically cutting the cord, and needle aponeurotomy (needle fasciotomy), where the surgeon uses a small needle-like blade to nick the cord to weaken it.

Non-surgical Treatment. Xiaflex is the only FDA-approved nonsurgical treatment for adults with Dupuytren’s contracture with a cord that can be felt. Xiaflex is injected directly into a Dupuytren’s cord, where it breaks down the cord’s collagen.

How Xiaflex Works
Xiaflex contains a mixture of enzymes designed to be injected directly into a Dupuytren’s cord. In the cord, these enzymes break down collagen, one of the main cord components, to help straighten the finger.

How Xiaflex is Administered
Xiaflex should be administered by a doctor experienced in injection procedures of the hand and in the treatment of patients with Dupuytren’s contracture.

XIAFLEX™ (collagenase enzyme) injection for Dupuytren’s contracture. Before, next day, and two weeks after first treatment

Injection Procedure (Day 1): A small needle will be used to inject Xiaflex directly into the cord that is causing your finger to bend. A gauze dressing will be applied to protect the treated hand. After the injection, you will have swelling and bruising in the treated hand. To help minimize swelling and bruising, you should limit movement of the treated finger and keep the treated hand elevated until the day after the injection. You will give you additional instructions about caring for your treated hand until your follow-up visit the next day.

Extension Procedure (Next Day Follow-Up): You will need to return the following day after the injection so that your finger can be evaluated. Your finger may straighten on its own before your follow-up visit, but you should not try to straighten it on your own.

If necessary, the doctor will attempt to extend, or straighten, your finger by applying moderate pressure. This extension procedure will likely be painful; you should discuss pain medication at that time. After your follow-up visit, you will be given a splint to wear at night for up to 4 months to help keep the treated finger straight. You’ll also need to do finger exercises several times a day for several months to help you regain mobility.

What to Expect From Treatment
Improvement in Contracture. Xiaflex treatment eliminates contracture in up to two-thirds of patients. Individual outcomes will depend on which joint and finger are affected and the amount of contracture before treatment.

Additional Follow-up Visits. If your finger does not straighten enough within 4 weeks of your initial treatment, you may need additional treatments. Your may be administered Xiaflex up to 3 times per cord, at approximately 4-week intervals.

If you Have More Than One Cord. Xiaflex is recommended to be used in one cord at a time. If you have palpable cords and contracture affecting more than one finger, the additional cords may be treated sequentially with Xiaflex.

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About Dr. John T. Knight

Dr. John T. Knight, the director of the Hand and Wrist Insitute, is widely regarded as one of the most prominent hand and wrist surgeons specializing in minimally invasive techniques for innovative treatments of hand, wrist and upper extremity injuries and disorders. Excelling in the area of advanced wrist arthroscopic procedures and stitchless endoscopic carpal tunnel release procedures, he has more than 20 years of experience and has performed over 15,000 procedures.