My Dupuytren’s surgery lately is going badly; do you have any suggestions for me?

Hello Doctor,

I had Dupuytren’s surgery on my right hand on August 3, 2012. Most of the surgery involved the area below my little finger with the incision extending upwards to the adjoining ring finger. A nodule on my palm was also removed from the base of my thumb. I began therapy on August 31, after complaining about the pain. After 3-4 sessions, the therapist felt I was progressing well enough that it wasn’t necessary for them to check my progress.

My concern is that lately I am experiencing some numbness in my fingertips, wrist pain, and a shooting pain up my right arm. Also, I am unable to make a fist when I wake up. It generally takes 2-3 hours before I can make a normal fist without too much pain. I continue to do the prescribed exercises and wear an Isotoner glove each night.

It appears to me that my healing process is going in the opposite direction it should be going after surgery, as the pain and lack of range of movement and poor flexibility were not that apparent 3 weeks after surgery. I’m regretting the surgery already, as I can no longer workout with weights or anything that requires squeezing.  Do you have any suggestions for me?

Thank you for any help or ideas you can provide.

 

Greetings,

While you did not name the type of Dupuytren hand surgery you had, based on your very brief description and commentary I will assume (but feel rather confident) that you had some type of palmar fasciectomy, with several different types possible depending on the amount of tissue removed during hand surgery. 

To understand this hand surgery it would be good to first explain the term, palmar fasciectomy. The word palmar refers to the palm of the hand, that broad area of the hand that is in contact with anything being held and to which the fingers are connected.   The word fasciectomy refers to surgery that is performed to remove fascia from the body.  Fascia is a thin but tough layer of soft fibrous tissue that covers, surrounds and lines all tissues, organs, structures and cavities of the body.  Fascia is as thin as, and in a way is used in the body like, the plastic Saran wrap that is used to cover and protect food.  You can see fascia as the pearly white thin tissue membrane found in cheaper grades of roasts and steaks.  There is normally a considerable amount of fascia tissue in the palm of the hand to provide extra strength, durability, support and protection during the heavy work done by the hands. 

The “-ectomy” ending of the word fasciectomy indicates the surgery is done through an opening in the skin, and that something is removed during the surgery – fascia in the case of a fasciectomy. 

The exact course and degree of tissue removal performed during a palmar fasciectomy is based on the patient’s age, occupation, family history of the Dupuytren’s contracture, duration, location and severity of finger  contracture or degree of reduced range of motion, level of disability, general health, as well as history of previous hand injury and prior hand surgery. 

With that explanation out of the way, let us discuss your situation. 

It is probably important to DCI readers that your email was received on October 15, 2012, approximately two and a half months after your hand operation.  This means that for approximately the first three weeks or month after your Dupuytren’s surgery your progress was good, but you are saying during the next six weeks you are having new hand and arm symptoms and that you now feel you are regressing.

You did not mention if this was your first Dupuytren’s surgery; this is important in regard to how you decide to manage your hand problem.  Since you did not mention prior hand surgery I will assume there was none. 

Your description of a very brief period of improvement – in your case about a month   followed by gradual appearance of numbness in the fingertips, wrist or hand pain, shooting pain in your  arm, stiffness and weakness in the involved arm is not uncommon for someone undergoing the rapid recurrence of Dupuytren’s contracture. There are many adverse things that can and do sometimes happen after even small or simple hand surgery that are totally unintended and unexpected.  Please see Dupuytren’s surgery risks for palmar fasciectomy for further discussion. 

I have no way of knowing if that is what is happening with you, but your flare up of symptoms fits in with the way that DC will always recur after surgery. On the other hand you could be going through some temporary complaints that are easily explained and common and consistent for the kind of Dupuytren’s surgery you had.  At this point I think you need to get some answers from someone who has direct knowledge and experience with the kind of surgery you had.

I suggest you go back to your surgeon and tell him exactly what you explained in your email to me.  If you receive a response that does not make sense to you, or you get brushed off with a hasty and unsatisfying reply, I suggest that you go for another opinion from a surgeon that is not associated with the surgeon who did your operation.     

Your story is a lot like many people who send me emails or call to discuss their results and side effects after Dupuytren hand surgery; I hear of bad results frequently and some much worse than what you are reporting.  From my perspective in doing this work since 2002 I observe that poor surgical results and aggravation or worsening of the original hand problem happen much more often than patients are being told prior to surgery; it seems that surgeons downplay the poor results and permanent pain, increased scarring, numbness and weakening that can happen.  They also seem to downplay the speed of Dupuytren recurrence; for some people it is never mentioned although it always recurs.   This is an unfortunate situation I hear about frequently.     

Lastly, I suggest that you consider doing your best to avoid additional hand surgery if at all possible.  The DCI site is all about the successful use of Alternative Medicine to support an encourage the natural healing of the Dupuytren’s nodules and cords.  Please spend some time looking over this information to see if it makes sense to you.  Let me know if I can assist you in any way.   TRH

 

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