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NA and Xiaflex on PIP Joint….Anyone have success?
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03/22/2014 04:08
cschieber 
03/22/2014 04:08
cschieber 
NA and Xiaflex on PIP Joint….Anyone have success?

Hello all. Haven't been here for a while since my cortisone shots two months ago gave me so much relief I rarely think about my DD. I'm seeing a new doctor on Monday who does NA but isn't convinced about PIP joints. I had NA for two PIPs with Dr. Denkler in January 2013 but contracture returned in several weeks and I developed triggers in both treated fingers causing much pain and limited range of motion, that didn't exist before the NA procedure. I don't know if I should try it again or not. Another hand surgeon in Philadelphia told me he did a xiaflex injection in a patient similar to me (PIP) with lousy results and patient was scheduled for surgery. I'm just wondering if anyone has had a successful NA, Xiaflex or surgical treatment of DD at the PIP joint. My affected fingers are RH index and LH middle finger. Thanks.

03/22/2014 15:49
cynrom 
03/22/2014 15:49
cynrom 
Re: NA and Xiaflex on PIP Joint….Anyone have success?

Hi, interesting read. Thank You for this info. I am 56yrs old, with DD in my family and have seen how crippling this disease can get. I have recently developed bilateral DD, with two large hard nodules in both pinky fingers (above and below the PIP joint) and one in each ring finger with several nodules and skin puckering on my palms. My pinky fingers are contracted at the PIP joint about 30% (bending at a rate of about 13% per year). I have knuckle pads and one nodule in my foot. I am not like most people with DD, I have NO visible cords! The Doc’s have said my cords are behind the nodules in my fingers. I have no pain, except for minimal nerve pain shooting thru the right pinky finger now and then. I have done extensive researched on NA, Xiaflex & Surgery and the pros and cons of each. Although I am a candidate for NA & Xiaflex, “I” have made the choice to have surgery on my RH in May. My Doc agrees that although he highly recommends NA & Xiaflex for others, because my DD is very aggressive, surgery would be the best course for me.

From what I have read, PIP joint contracture is the hardest to treat (pinky finger being the worst) and you should treat it at an earlier stage (20% bend) for a better outcome. NA & Xiaflex almost always don’t last long when it involves the PIP joint and in some cases, it doesn’t work at all; as in surgery also. Plus, for me, I have a real problem with a Doc sticking a needle into my PIP joint that has no visible cord.

The choices for treating DD are a crap shoot for each individual person. You don’t know your outcome until you have it done; there is no permanent cure and no guarantee. What works for you might not work for someone else. I don’t know how my surgery will turn out (I could be making the wrong choice and I am very nervous) and I’ll never know if NA or Xiaflex would have been a better choice. I’m doing what I feel is best for me; all three options have risk factors attached to the procedure with a NO guarantee price tag attached!

You had NA once with a bad outcome and some Doc’s have expressed their opinions to you about NA & Xiaflex treatment on the PIP joint. Maybe it’s time for you to have surgery? It’s a decision you have to make on your own and whatever you decide, you will not know whether it was a good decision until it’s done! Good Luck!

Cyndi

03/22/2014 16:16
spanishbuddha 

Administrator

03/22/2014 16:16
spanishbuddha 

Administrator

Re: NA and Xiaflex on PIP Joint….Anyone have success?

Welcome Cyndi

Thanks for sharing your thoughts and condition. It's sounds to me though as if you do not really have a treatment choice. Both NA and Xiaflex need a visible or palpable cord for the doctor to work with. You say you don't have that? I think any of the interventional treatments for the PIP and pinkie can be difficult, so ensure your surgeon has lots of good experience.

Best wishes

SB

03/22/2014 16:46
cynrom 
03/22/2014 16:46
cynrom 
Re: NA and Xiaflex on PIP Joint….Anyone have success?

SB: Correct! No visible cord(s) anywhere! So I was very surprised when one DD specialist said he could do Xiaflex. Also, NA & Xiaflex do not get rid of the nodules? and I have at least 7 throughout my palm & fingers; that I can count! No use putting a band-aid over the problem (NA/Xiaflex) when the end result will be surgery. Get it done! I am from Canada and the surgeon I have chosen (and I have seen several) is originally from the UK. The medical staff speaks very highly of him here in my town. However, that doesn’t mean success. I’m keeping a positive attitude and reading lots of info on pre & post-op care. If surgery doesn’t go well, then I may consider trying the Xiaflex for the left hand which needs treatment next. At least the surgeon would know where the cords are since the left is a clone of the right! lol Thanks for your best wishes! Cyndi

03/22/2014 17:29
callie 
03/22/2014 17:29
callie 
Re: NA and Xiaflex on PIP Joint….Anyone have success?

Cyndi,

I had surgery on my little finger 12 years ago. The finger had 90 degrees contracture and was aggressive. There is no trace of Dupuytren's in that hand now. So it can be done. There was very little pain with the entire procedure and recovery. I did not need any pain pills except Tylenol for a few days.

03/22/2014 17:35
mikes 
03/22/2014 17:35
mikes 
Re: NA and Xiaflex on PIP Joint….Anyone have success?

I suppose I was extremely lucky. I had a 90+ degree PIP pinkie contracture and had Dr. Denkler perform NA in November 2006. It is almost perfectly straight to this day. Unfortunately, I do have other symptoms at this point.

03/25/2014 22:57
cschieber 
03/25/2014 22:57
cschieber 
Re: NA and Xiaflex on PIP Joint….Anyone have success?

Hi Cyndi and welcome. I, too, have no obvious cords. Even so, Dr. Denkler managed to poke at them until they snapped (I heard it) but it didn't last. I think surgery is in my future too. My contractures are at about 20 degrees and every surgeon I've been to says it's too soon to operate. They get no argument from me as I'm in no hurry to have surgery. I also have knuckle pads on five fingers. I will never have them removed though as I have read many accounts that they come back with a vengeance. Good luck in May. Please let us know how things go.

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