Hi, a newbie here. I am 31 and have nodules, cords, and depressions in my right hand. The first nodule appeared about 7 years ago. I can't hyperextend 3 fingers, but can just about get my hand flat on the table.

I have recently been refered by my GP to see a othopedic surgeon to take a look at my dupytrens. As seems to be the a common response, he basically said to do nothing till it gets worse.

I asked him about Xiapex and he told me about what it does etc. but has yet to use it on any patient. I'm wondering if I should try to get referred to see another doc that has more experience with this, or if I should trust the docs advice that waiting is the best option. There seems to be so many conflicting view on this, It is hard to know which ones to believe, and what is the best treatment.

I really don't want surgury, so want to do whatever I can to slow the progression. Any advice?

Many thanks in advance.

Hi Gary,

your post gives a very good overview of options. Just wanted to add that collagenase injection (Xiapex) and needle fasciotomy (PNF; NA) are typically only done with a contracture of at least 20 degree.

Wolfgang

Based on my research and personal experience I recommend getting X-ray treatment as soon as possible. If you live in Europe it is a quick hop to Essen to have the XRT done by the people with the most experience and the rates for non-citizens are much cheaper than the costs with medical insurance in the USA. And lots of sightseeing opportunities around Essen while have the treatments done as they take up only one hour of the day.

NA and Xiaflex are options for releasing contractures and reducing the size of nodules. I would expect better results on nodules with the Xiaflex and it actually dissolves the tissue. NA is 1/3 to 1/4 the cost of Xiaflex and multiple areas can be treated. In the USA the insurance companies pay for the first Xiaflex vial but if more are needed the patient pays at a cost of $4000 per vial plus the office visits with the hand surgeon. Insurance in the USA only covers contractures and not general problems like nodule if they do not restrict the opening of the fingers at the joints.

bstenman:

---

... NA and Xiaflex are options for releasing contractures and reducing the size of nodules. I would expect better results on nodules with the Xiaflex and it actually dissolves the tissue. NA is 1/3 to 1/4 the cost of Xiaflex and multiple areas can be treated. In the USA the insurance companies pay for the first Xiaflex vial but if more are needed the patient pays at a nly cost of $4000 per vial plus the office visits with the hand surgeon. Insurance in the USA only covers contractures and not general problems like nodule if they do not restrict the opening of the fingers at the joints.

Edited 06/09/12 20:41

The website for the company that produces Xiaflex lists the doctors that it has approved for injecting it. Most of these however have very little hands on experience with Dupuytren's and I would not both with someone who has not treated dozens of patients. I purposely drove 120 miles to see Dr. Denkler who has done hundreds of NA procedures and Xiaflex treatments to get his advice as to which to do for my hands and I followed his recommendations.

General practitioners have their place but they are woefully ignorant of Dupuytren's and are no more in a position to give advice then your dental hygienist. This website is an excellent source and you can also check with hand surgeons in your area to find someone who does both NA and Xiaflex and has a track record with both.

NA is cheaper, has a shorter recovery time, and should be considered along with Xiaflex as a treatment. If you have more than one finger to treat then NA is better as the insurance companies will cover the entire process on multiple digits and multiple hands as I had done. With Xiaflex the insurance companies will only cover the $3500 cost for the first vial and it will only be enough to treat one section of one hand.