What Is Dupuytrens Contracture
Dupuytrens contracture is a hand deformity that develops over a span of several years and is not dangerous, although it can be rather awkward or inconvenient, and it can return after treatment. When you have Dupuytrens, too much collagen builds up in the hand and your body is not able to properly break it down. The excess collagen forms into hard bumps or chords that pull on the fingers, leaving them stuck in a bent position.
Dupuytrens can affect any of your fingers, but is more likely to affect the ring and pinky finger. This can make everyday tasks that require normal use of your hand very difficult.
Q: Other Than Needle Aponeurotomy Are There Other Alternative Treatments For Dupuytrens Contracture
A: Yes. As before Needle Aponeurotomy was introduced, one option is to undergo traditional, open surgery, which is still a viable option for complex Dupuytrens Contracture. If indicated, the specific approach for Fasciotomy is determined by our Surgeon at the time of your in-office consultation. A second, newer option is treatment via a collagen-based injection , which was recently approved by the U.S. Food and Drug Administration in February 2010. Our Center is presently further analyzing the benefits and risks of Xiaflex. To learn more about Xiaflex visit www.xiaflex.com.
Why It Is Done
Dupuytren’s disease causes tissue under the skin of the palm of your hand, called the palmar fascia, to get thicker and shorter. This can pull and bend the fingers in toward the palm. Needle aponeurotomy is done to release the tight tissue in the hands and improve the use of the hands.
Needle aponeurotomy is an alternative to hand surgery, which is called fasciectomy. For this surgery, the palm is cut open and the tight tissue is removed. Compared to surgery, needle aponeurotomy:
- Is less invasive.
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Cost Of Treatment For Dupuytren Contracture Using Alternative Medicine
While the ultimate Alternative Medicine cost to treat Dupuytren contracture is also dependent on the same variables as medical care, the cost for four months of non-drug and non-surgical care with a DCI based medium treatment plan would be $520. Bear in mind that this form of treatment does not have any side effects, will not result in more contracted tissue, nerve damage or ruptured tendons, presents no possibility for infections, and does not require physical therapy rehabilitation.
Cost is not the only factor, but satisfaction after treatment based on safety and reduced complications. These last issues are very important to also consider when assessing the cost of treatment for Dupuytren treatment.
How Much Does Needle Aponeurotomy Cost With Medicare
Medicare Part B is optional and comes with a standard monthly premium of $148.50 per month in 2021. Beneficiaries are also typically responsible for a coinsurance payment of 20% of the Medicare-approved amount for services after meeting the annual deductible, which is $203 for the year in 2021.
Research published in 2019 showed that the average cost for needle aponeurotomy were $624 per finger.
This means that your Medicare Part B coinsurance or copays could add up quickly. If your needle aponeurotomy is covered by Medicare, you might benefit from having a Medicare Supplement plan that could pay for your Medicare Part B coinsurance and copays.
Medicare Supplement plans can pay for a number of other out-of-pocket Medicare costs as well, which can help protect you from potentially high health care costs and surprise medical bills. You can compare Medicare Supplement plans online for free, with no obligation to enroll.
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Personal Stories About Having Surgery For Dupuytren’s Disease
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have a mild case of Dupuytren’s disease, which means my ring finger is somewhat curled and won’t lie flat. I know there are risks with any surgery, so I don’t want to have surgery unless I really need to. For now, I can still do all the things I need to do. Surgery is not the choice for me right now.
Richard, age 50
My fingers have lost most of their mobility, and it’s increasingly difficult for me to drive or wash the dishes. For over 10 years, my doctor and I have been talking about the possibility of surgery, and I think it’s time. I’m aware that the disease may return, but it’s worth it to have some relief and to be able to use my hands again. I’m going to talk to my doctor about surgery and also about a simpler treatment I’ve heard about called aponeurotomy.
My parents both have Dupuytren’s disease, and I developed a nodule when I was still in my 30s. I exercise my hands several times a day, but my fingers are getting a little more and more bent all the time. It’s getting hard to pick up objects, button my clothes, and put on gloves. I’m concerned about the risks of surgery and the good possibility that the condition will return after surgery. I’m going to try a collagenase injection to see if I can avoid surgery.
Jim, age 59
Ken, age 81
Q: After Needle Aponeurotomy Is Performed What Can I Expect
A: Following your procedure, our Physician and Staff will provide you with specific instructions. In generally, you can plan on the option to drive yourself to and from our Center the day of your procedure. For the first 5-10 days following your procedure, you should plan to limit yourself from any heavy or forceful gripping, grasping and squeezing in order to allow the soft tissues to heal. Thereafter you should be comfortable enough to resume all of your normal daily activities. If any questions arise following your procedure, know that our Physician and Staff are always available to answer these questions for you.
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When Should A Doctor Recommend Surgery For Dupuytrens
As we mentioned, surgery for Dupuytrens should be considered when all other options have failed. Dupuytrens is a mostly painless disease, so many patients choose to put up with the inconvenience of hand deformities. This is usually the case for older adults who have other medical conditions that they view as more serious and concerning.
Dupuytren’s surgeries are considered elective because Dupuytrens is not a life-threatening illness. Therefore, you may choose not to have any surgery for several years, but you may change your mind later if the condition has advanced to severely impact your life.
What Other Treatments Can Alleviate Dupuytrens Symptoms
Doctors often suggest that someone tries several different treatments before recommending surgery. It’s most important to see your doctor as soon as you begin to notice signs of Dupuytrens Contracture. Some of the most obvious signs are a hard bump on the palm, thickened skin on the hand, or the inability to lie the hand flat on a table.
Exercises to maintain movement in the fingers and hand are an effective way to keep blood flowing. Similarly, if you stop or minimize your use of vibrating tools such as jackhammers and hair clippers, you can help prevent symptoms since this places someone at risk for the condition.
Several patients have found that massaging all-natural contracture cream into the palm of the hand has greatly reduced their pain. Our all-natural cream helps reduce inflammation in the hand and break down scar tissue that pulls on the fingers. Using this cream twice a day will not only help reduce inflammation but it also encourages blood flow to the hand and fingers.
There is the possibility these latter options won’t work, in which case you may need surgery. If any symptoms continue to negatively impact your life in a major way, you may find that surgery is the only answer.
Cost Of Treatment For Dupuytren Contracture Surgical Release Needle Aponeurotomy Xiaflex Enzyme Injections
As a cost reference point, here are price ranges to compare total cost of treatment for Dupuytren contracture for the basic medical procedures currently available, per hand involvement:
Open hand surgery $10,000-$16,000
Radiotherapy $6,000-$10,000 one report on the internet of a $20,000 RT
Needle aponeurotomy $700-1,000 per finger one report of $3,000 cost at Mayo Clinic
Xiaflex injection $7,000-9,000 per finger
Because of the high costs for many forms of Dupuytren care in the U.S., a new industry has emerged which has been called medical tourism or vacation medical care. In this scenario a patient from a high-cost country will travel to a lower-cost country to receive medical care. While in that country the patient will often arrive days or weeks before the surgery to have a vacation there. After the surgery is done and no complications or adverse reactions are evident the patient will return home.
Some host countries have a large and thriving medical tourism industry based on low cost lodging, food and recreation opportunities, and subsequently can also offer lower prices for what is reported to be the same or better surgical repair of Dupuytren contracture at lower fees, such asIn U.S. dollars
Tunisia $ 980
What Aggravates Dupuytrens Contracture
There are a number of risk factors for Dupuytrens contracture.
People who have type 2 diabetes, consume alcohol and tobacco, or take certain medications for seizures are at higher risk for developing Dupuytrens contracture.
Also, being older, a male, having Scandinavian or Northern European background, or a family history of Dupuytrens contracture puts you at higher risk for the condition.
Additionally, limited research has shown that stretching and splinting can potentially aggravate Dupuytrens contracture.
While Dupuytrens contracture might only affect one hand, its common for the condition to affect both hands, as well.
Sometimes, a person can have a similar contracture of the feet with a condition called Ledderhose disease.
Dupuytrens contracture is also associated with Peyronies disease, which is a contracture of the penis.
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Does Medicare Cover Xiaflex
The human body is designed in such a way as to function within limits. These limits are set using structural connectivity through joints, tendons, ligaments, muscle fibers and other self-limiting tissue. The reason behind this functionality is to allow for range of motion without pain, but sometimes, tissue damage or disease can have a negative effect on these connective elements, leading to deformities. Not only can these problems cause pain or limit range of motion, but they can also lead to self-esteem concerns, especially when they occur in sensitive areas like the genitals.
Although there are many ways in which connective tissue can be damaged or limited due to injury or disease, two common conditions are Dupuytrens contracture and Peyronies disease. In Dupuytrens contracture, the fingers are pulled in toward the middle of the palm due to fibrous tissue growth. This limits motion and can potentially lead to strain, injury and pain. People suffering from this condition may also be more prone to injury in the hand when everyday actions, such as opening a door, lead to additional strain on tendons that are inflexible.
What is Xiaflex?
Does Medicare Cover Xiaflex?
Needle Aponeurotomy: Medicare Coverage For Dupuytrens Disease
- Medicare may cover needle aponeurotomy to treat Dupuytrens contracture, but only if your doctor decides its medically necessary. Medicare may also cover collagenase injections like Xiaflex, but you should learn what to ask your doctor before seeking treatment.
Needle aponeurotomy is a treatment for contracture caused by Dupuytrens disease. Dupuytrens contracture is a thickening of tissue under the skin of a persons palm that causes the fingers to bend inwards toward the palm without being able to straighten.
Medicare may cover needle aponeurotomy to treat Dupuytrens contracture, but only if your doctor deems it medically necessary for your health and quality of life. If your doctor similarly documents that collagenase injections such as Xiaflex are necessary treatment, Medicare may cover the collagenase injections.
Needle aponeurotomy involves inserting a needle into the skin to puncture and break up the tissue thats causing a finger to contract. Contractures can reoccur, and the procedure can be repeated.
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Q: Is Anesthesia Necessary For Needle Aponeurotomy
A: Needle Aponeurotomy is performed under local anesthesia, which is administered by injection at our Center. During your procedure, you are completely awake. This is necessary so that our Physician can communicate with you during the progressive stages of Needle Aponeurotomy treatment. There is no need for general or intravenous anesthesia therefore, there are no eating and drinking restrictions before and after your procedure. You can even plan to drive yourself to and from our Center on the day of your procedure. If you are concerned about being awake for your procedure, our Physician will be glad to discuss alternatives for you.
Dupuytrens Treatment: Cch Collagenase Injection
A common alternative to surgery for Dupuytrens is an injectable form of collagenase clostridium histolyticum , which is an enzyme extracted from bacteria. These enzymes break down the collagen buildup in the hand that causes lumps and chords in Dupuytrens.
Xiaflex is the only CCH injection on the market. It shows low recurrence rates of Dupuytrens contracture and often provides fast, effective results. Patients receive a CCH injection dosage of varying volume and potency, depending on the location of the chords and contracture. Normally, patients receive one injection per localized collagen buildup, or one per affected joint/finger. Patients are then typically given a splint to help regain finger extension. Within a few days of receiving the injection, patients meet with the doctor who will then further the breakup and dissolvement of the collagen through manipulations or massages to the hand while youre under local anesthesia.
Over the last decade, CCH injection has become a more popular form of treatment for mild as well as advanced cases of Dupuytrens than surgery. According to a Dupuytrens treatment research study published in the journal HAND in 2016, CCH injection treatment has increased significantly since its FDA approval in 2010 and increased proportionately to the decrease in palmar fasciectomy .
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What Happens After The Procedure
Most likely, your treated hand will swell. You can reduce the swelling through cold compress and by keeping your fingers moving.
The treated hand will be numb or will feel tingling for 1-2 days. Throughout the day for a couple of weeks, you will wear a splint intermittently, and you will wear them for a couple of months throughout the night.
It is recommended that you perform gentle finger bending and stretching. Do not worry after a day or two or if your doctor performs the procedure, you will be able to resume regular activities.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
What Is The Progression Rate Of Dupuytrens Contracture
Dupuytrens contracture is a progressive condition that involves the thickening of the fibrous layer of tissue beneath the skin, which results in the fingers being pulled inward. It mostly affects the ring and pinky fingers.
This condition usually progresses slowly over years or even decades. However, theres not enough research to determine the average span for the progression of Dupuytrens contracture.
Most who develop it are men over age 50. If a younger man develops Dupuytrens contracture, the condition usually progresses more quickly and tends to be more severe. Otherwise, many people may have a mild case that requires no treatment.
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How To Know If You Have Dupuytrens Contracture
Dupuytrens disease usually takes a long time to develop. You may notice the following symptoms if you have this medical condition.
- Nodules: You might see one or more lumps in the palm of your hand. At first, the nodules may be tender, but they get thicker and more rigid over time. You may also have a deep indentation in the skin by the nodules.
- Cords: As the nodules contract and thicken, the tissue under your skin develops into dense, tough cords. They can prevent your fingers or thumb from spreading apart or straightening.
- Contractures: The tight cords pull one or more of your fingers toward the palm, reducing their mobility. Your ring and little fingers are most prone to contractures, but any of your fingers, even the thumb, could develop them. You will most commonly see a contracture near the knuckle.
- Limited use of your hand: As Dupuytrens contracture develops, you might have difficulty keeping your finger straight. Pay attention to what happens during simple activities, such as holding large objects or putting your hand in your pocket. Your doctor may ask you to place your hand flat on the table. If you cannot do so, you may have Dupuytrens contracture.
How To Use The Xiaflex Copay Assistance Program
There are 2 ways to register for the XIAFLEX® Copay Assistance Program. It just depends on how the doctor orders the treatment.
If the doctor:
Ordered XIAFLEX® directly
Ordered XIAFLEX® from US Bioservices Specialty Pharmacy
After confirming your shipment, contact the doctor’s office to schedule your injection of XIAFLEX®.
For more information about Specialty Pharmacies, please download the Specialty Pharmacy Information Card.
Before enrolling in the XIAFLEX® Copay Assistance Program, its important to identify if you are eligible. The information below may help you determine that. You can also call 877-XIAFLEX for more assistance.
Restrictions apply. See full terms and conditions.
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