Is it normal to have numb fingers after Dupuytren hand surgery?

hi doctor.
i had a fasciectomy 8 days ago for dupuytrens, yesterday i returned to hospital for re-dressing and hand clinic. When i returned home i felt my little finger and it was slightly numb around the tip and nail. i had not noticed this the previous week due to the dressing and splint holding my little, and ring fingers up. i’m just now wondering is this normal after that type of surgery and is it likely to return to normal. thank you
p.s i’m 31 years old

 

Greetings,

Palmar fasciectomy for Dupuytren’s contracture is typically a rather extensive and difficult  surgery; all hand surgery is complex because of the nature of hand anatomy.   Hand surgery is complex because the hand is such a tightly packed area in which muscles, tendons, ligaments, nerves, blood vessels – and of course fascia are extremely close together with no open spaces or extra room in which to maneuver.   This complexity is better understood when you consider that in Dupuytren hand surgery there is foreign tissue in the handthe internal Dupuytren cordswhich are not supposed to be in the palm of the hand.  This extra tissue crowds into an already crowded part of the body.   Thus, a hand surgeon is faced with an especially complex and difficult task when she enters into such a situation.

A certain degree of temporary numbness and pain is to be expected after such a operation like a palmar fasciectomy.  A lot of delicate tissue was cut up, handled, stretched and probed, moved around, sewn up and altered in ways that the tissue have never experienced before.  Any numbness is understandable because delicate nerve tissue was traumatized in surgery, but these ares of numbness should pass in time; perhaps a month or two or more.  There is also the possibility that all or a portion of the numbness that you now have will remain.  The numbness might even increase because of tissue changes within the palm that might take place over the next several months as the hand heals after surgery; there is always a possibility that internal scar tissue will develop that can apply pressure or traction on nerves that could result in more numbness or even pain.  Anything is possible.   

It is unfortunate that you have not had any of this explained to you by your surgeon, for two reasons.  First, this would be especially true if your doctor knows you had a relatively easy and uneventful hand operation and it should have been explained that any numbness would be temporary and limited, so that you would not worry unnecessarily as you are now doing.  Or, second,  perhaps if the surgeon knew you had a relatively difficult and nasty hand operation.  It should have been explained to you that permanent numbness was unavoidable under the circumstances, so you would be prepared for the future – as you are not now prepared because apparently none of this was discussed with you.

Assuming that you surgeon is not a good communicator, I will further assume that something very important was also not explained to you.  Allow me to caution you that palmar fasciectomy is never a permanent correction or solution for Dupuytren’s contracture.  After any kind of Dupuytren’s surgery there is a tendency for the hand problem to recur; some types of Dupuytrens hand surgery have a faster recurrence rate than others, but they all are plagued by recurrence eventually.  You did not mention the type of of palmar fasciectomy you had, but for example in a partial palmar fasciectomy the recurrence rate is 66% in five years.   This means that after a palmar fasciectomy 2/3 or 66% of those patients will have recurrence by the 5th year.  What about the other 1/3 or 34% who do not have recurrence by year five?  They will likely have a recurrence in the 6th, 7th, 11th or later year, but it will recur.

This  Dupuytrens contracture recurrence after hand surgery is the reason why you will hear of so many people who have more than one had surgery on the same hand.

This number does not express the fact that of the 66% whose Dupuytren problem comes back within five years, not all of those patients have the recurrence happen in the 5th year; some have recurrence in the 4th, 3nd or 2nd year, and some even in the first year.  

You might say to yourself that this is a risk you are willing to take because you might be one of the lucky ones who does not have Dupuytrens recurrence until the 10th year or later after the palmar fasciectomy.  Yes, this is possible and perhaps you are willing to take that risk.  But, it is also true that after having the first hand surgery, the recurrence rate increases or gets faster for the second and all succeeding surgeries.   This means that  after developing a recurrence of Dupuytren’s contracture, in two years or 12 years or whatever,  if you choose to have a second palmar fasciectomy the recurrence rate will be sooner or faster than it was after the first hand surgery.   Further, if you have a third recurrence and have another hand surgery the recurrence rate will be even faster than after the second surgery.   Some patients who have a fast recurrence rate after the first surgery get into trouble rather quickly.

At age 31, as young as you are, you have many long and wonderful years ahead of you.  Because you have a lot of time to eventually have a recurrence of Dupuytren’s contracture, I caution you to take especially good care of both hands, do everything  you possibly can to keep your hands healthy and to do all that you can to avoid that second hand surgery.

The Dupuytren’s Contracture Institute is devoted to the non-surgical and non-drug treatment of this terrible hand problem.  It might be of interest and treat value to you to spend some time reading about the Alternative Medicine method we have researched to assist the self-repair of Dupuytren’s contracture.

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