Non-Surgical Treatment to Straighten Bent Fingers
At California Pacific Orthopaedics in San Francisco, we understand how frustrating it is when your hands stop working the way they should. If Dupuytren’s contracture is causing your fingers to curl toward your palm, you may not need surgery to fix it. We offer Xiaflex®—a prescription injection that can straighten your fingers and help you get back to your daily life.
Overview
Dupuytren’s contracture is a condition that affects the layer of tissue under the skin of your palm. Over time, knots of tissue form and eventually create a thick cord that pulls one or more fingers into a bent position. When this happens, you cannot straighten your finger completely.
Xiaflex (collagenase clostridium histolyticum) is the first and only FDA-approved non-surgical treatment for this condition. Instead of using a scalpel to cut the tight tissue, doctors use this special injection to dissolve it.
The medicine is an enzyme—a biological substance that breaks down collagen. Since the tight cord in your hand is made mostly of collagen, the injection weakens the cord. This allows your doctor to gently stretch and straighten the finger a few days later, breaking the cord without the need for open surgery.
At California Pacific Orthopaedics, our board-certified hand surgeons are experts in this treatment. We help patients from all over the San Francisco Bay Area restore hand function with less downtime than traditional surgery.
Why This Procedure Is Done
The primary goal of Xiaflex treatment is to improve the range of motion in your hand. When Dupuytren’s contracture progresses, it can severely limit your ability to perform basic tasks.
The procedure is done to release the tension caused by the palmar fascia (the tissue under your palm skin) thickening and tightening. This tightening is what creates the “cord” that tethers your finger down.
Who is a Good Candidate?
You might be a good candidate for Xiaflex injections if:
- You have a palpable cord: Your doctor can feel a distinct cord of tissue under the skin of your palm.
- Your finger is bent: The contracture has bent your finger enough that it is difficult to place your hand flat on a table (the “tabletop test”).
- You want to avoid surgery: You are looking for a less invasive option than open hand surgery (fasciectomy) and want a faster return to light activities.
- You have healthy healing ability: While safer than surgery for many, you still need to be able to heal from minor swelling and bruising.
Your doctor at California Pacific Orthopaedics will evaluate the severity of your bend (measured in degrees) to see if this injection is the right choice for you.
What To Expect: Before the Procedure
Getting Xiaflex is a two-step process that usually happens over two separate office visits. Because it is not surgery, the preparation is much simpler, but there are still important things to know.
Consultation and Exam
First, you will meet with one of our hand specialists at our San Francisco office. They will:
- Examine your hand to locate the cord.
- Measure how much your finger is bent.
- Discuss your medical history, specifically asking about bleeding disorders or blood thinners.
Preparing for the Appointment
- Medications: You may be asked to stop taking blood thinners (like aspirin, ibuprofen, or prescription anticoagulants) for a few days before the injection to reduce the risk of severe bruising.
- Logistics: Plan to have two appointments. The first is for the injection. The second, usually 24 to 72 hours later, is for the “manipulation” (straightening) of the finger.
- Support: You can drive yourself home after the first appointment, but your hand might be sore.
What To Expect: During the Procedure
The treatment takes place in two stages. Both are performed right in our clinic—no hospital stay is required.
Visit 1: The Injection
The first visit is quick, usually lasting about 15 to 30 minutes.
- Locating the Cord: The doctor will mark the specific area of the cord that is causing the bend.
- Injection: The doctor injects the Xiaflex medicine directly into the cord. You might feel a sting or a pinch, similar to getting a flu shot or a blood draw.
- Bandaging: A soft bandage will be placed on your hand.
- Going Home: You will go home with instructions not to use the hand. Do not try to straighten the finger yourself yet. The medicine needs time to work and dissolve the collagen. It is normal for the hand to swell and bruise significantly during this time.
Visit 2: The Finger Extension (Manipulation)
You will return to our office 1 to 3 days later for the second step.
- Numbing: The doctor will inject a local anesthetic (numbing medicine) to make your hand comfortable.
- Releasing the Cord: Once your hand is numb, the doctor will carefully extend and stretch your finger. This motion snaps the cord that was weakened by the enzyme. You typically will not feel pain during this, though you might hear or feel a “pop” as the cord breaks.
- Check Results: You will likely see an immediate improvement in how straight your finger can go.
- Splinting: A custom splint will be molded to your hand to keep the finger straight while it heals.
What To Expect: After the Procedure
Recovery from Xiaflex is generally faster than recovery from surgery, but your hand will still need care and attention.
The First Week
- Swelling and Bruising: It is very common for the hand to look purple and swollen. This can sometimes extend up the forearm. This is a normal reaction to the enzyme and usually peaks within a couple of days before subsiding.
- Pain Management: Most patients manage discomfort with over-the-counter pain relievers and by keeping the hand elevated (propped up on a pillow) to reduce throbbing.
- Skin Tears: Occasionally, as the finger is straightened, the skin (which has been tight for a long time) may tear slightly. If this happens, your doctor will dress the wound, and it typically heals on its own within a week or two.
Ongoing Care and Splinting
To get the best long-term results, you must follow the post-procedure instructions:
- Night Splint: You will likely need to wear your splint at night for several months (usually up to 4 months). This prevents the finger from curling back down while you sleep.
- Exercises: Your doctor or a hand therapist will give you specific finger exercises. These “range of motion” exercises help reduce stiffness and ensure the finger stays straight.
- Return to Activity: Many patients can return to light activities (like typing or eating) within a few days. Heavier activities, like golf or tennis, may need to wait 2 to 4 weeks, depending on how your skin and tissue heal.
Comparison: Xiaflex vs. Traditional Surgery
Many patients in the Bay Area ask us how this injection compares to standard surgery (fasciectomy). Here is a simple breakdown to help you understand the differences.
| Feature | Xiaflex Injection | Open Surgery (Fasciectomy) |
| Invasiveness | Minimally invasive (needle only) | Invasive (incisions and stitches) |
| Anesthesia | None or Local (numbing only) | General or Regional (sedation) |
| Recovery Time | Days to Weeks | Weeks to Months |
| Physical Therapy | Minimal | Often Required |
| Scarring | None (unless skin tears) | Permanent scar on palm |
| Recurrence Risk | Moderate | Low to Moderate |
While surgery is sometimes necessary for very severe or complex cases, Xiaflex offers a “middle ground” that is highly effective for many people.
Risks and Possible Side Effects
Like any medical procedure, Xiaflex injections carry some risks. Your safety is our top priority at California Pacific Orthopaedics, and we will discuss these with you in detail.
Common Side Effects:
- Swelling of the hand (edema).
- Bruising or bleeding at the injection site.
- Pain in the hand or arm.
- Itching or redness.
- Swollen lymph nodes in the armpit (tenderness under the arm).
Rare but Serious Risks:
- Tendon Rupture: In very rare cases, the enzyme could weaken a tendon used to bend the finger. This is why it is critical to have the procedure done by a board-certified hand surgeon who knows the anatomy perfectly.
- Nerve Injury: There is a small risk of temporary numbness or tingling if a nerve is irritated.
- Allergic Reaction: While rare, some patients may have an allergic reaction to the enzyme.
We monitor all patients closely to minimize these risks.
Frequently Asked Questions
Is the Xiaflex injection painful?
Most patients report mild to moderate pain during the injection, similar to a bee sting. The hand can be sore for a day or two afterward. During the second visit (the straightening), we use local anesthesia so you do not feel pain when the cord is broken.
Will the contracture come back?
There is no permanent “cure” for Dupuytren’s disease, regardless of the treatment. Whether you have surgery or injections, the tissue can thicken again over time. Clinical studies show the contracture may recur after a few years. The good news is that Xiaflex injections can often be repeated if the condition returns.
Does insurance cover Xiaflex?
Yes, most major insurance plans and Medicare cover Xiaflex for the treatment of Dupuytren’s contracture when medically necessary. Our office staff can help verify your benefits before your appointment.
Can I treat multiple fingers at once?
In some cases, yes. Your doctor can discuss if it is safe to inject two cords in the same hand during one visit. However, treating both hands at the same time is usually avoided so you are not left without the use of either hand during recovery.
Why Choose California Pacific Orthopaedics?
Your hands are your connection to the world. When it comes to treating delicate structures like nerves, tendons, and fascia, experience matters.
- Expert Hand Surgeons – Our team includes fellowship-trained hand surgeons who specialize specifically in conditions of the hand, wrist, and elbow. We are not just general orthopedists; we have deep expertise in the intricate anatomy of the hand.
- San Francisco’s Local Care – We are proud to serve the San Francisco community. From our convenient location near Pacific Heights and Presidio Heights, we offer top-tier orthopedic care without the need to travel far.
- Patient-Centered Approach – We believe in a “ladder of care.” We start with the most conservative, effective options—like Xiaflex—before suggesting surgery. We take the time to explain your condition and help you make the decision that fits your lifestyle, whether you are an artist, a tech worker, or a retiree.
Take the First Step Toward Straight Fingers
Don’t let bent fingers limit what you can do. If you are struggling to put on gloves, shake hands, or pick up objects, we can help.
Ready to see if Xiaflex is right for you?
Click here to schedule a consultation with one of our San Francisco hand specialists today, or call us at (415) 668-8010. Let’s get your hands back to work.
