Can Dupuytren contracture recur after I have hand surgery?

Recurrence of Dupuytren contracture is common and impossible to predict

In general, Dupuytren contracture recurrence means that is spite of hand surgery, the shortened, thickened tissue appears to return to the area of previous surgery, but actually is a continuation of the extension or progression of the disease into tissue previously unaffected.  Many surgeons openly speculate that Dupuytren contracture surgery accelerates the rate and extent of the disease progression.

In broad terms, the rate of Dupuytren’s recurrence after needle aponeurotomy (palmar fasciotomy) is considerably higher than for traditional open hand surgery (palmar fasciectomy).

Avoid surgery if possible with natural Dupuytren treatment

Any type of hand surgery done to release the contractures of Dupuytren disease can eventually result in the return of more contractures.  This recurrence if followed by another hand surgery can result in the return of more contractures eventually.  While this cycle of surgery and reappearance of more contractures proceeds, the patient is exposed to the potential risks of hand surgery each time it is done: permanent numbness, reduced finger movement, reduced hand strength, reduced sensations and pain.

To avoid this cycle the patient should consider the use of a brief therapeutic trial of Alternative Medicine as a conservative and essentially risk free option that could make surgery unnecessary.

Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation in the palm.  Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider conservative treatment options before attempting irreversible surgery.  To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

What is Dupuytren contracture recurrence?

The wide range of recurrence rates represent only gross estimates because there is no formally accepted definition of this term, so what characterizes a reappearance of Dupuytren contracture varies from one study or doctor to the next.  Recurrence of Dupuytren contracture can be:

  1. A finger or hand that received a prior Dupuytren surgery had to be operated on again for any one of a variety of reasons.
  2. The condition of a finger or hand worsened after hand surgery, without evidence of even initial improvement.  Sometimes the worsening is determined to be any degree of flexion deformity greater than prior to surgery, and sometimes must be a 5-10 degree increase.
  3. The condition of a finger or hand was initially good after Dupuytren surgery, but after time some degree of finger flexion returned to that finger or hand.  Sometimes the return is determined to be any degree of flexion deformity greater than the level of correction initially provided after surgery and sometimes it must be a 20-30 degree increase greater than the level of correction initially provided after surgery.

“The greatest French surgeon of the 19th century,” Guillaume Dupuytren, battled with the problem of reappearance of this disease after surgery. He experimented with a variety of tactics and methods to minimize the return but none were totally successful, just as it is today.

How often does Dupuytren contracture come back after hand surgery?

The general consensus is that after having conservative surgery by needle aponeurotomy, 50% of patients see a return of the same or worse contracture just three years later.  But after having more invasive open hand Dupuytren surgery, 50% of patients will notice a reappearance of the same or worse contracture five years later.  It seems that Dupuytren contracture will tend to come back over time to the same 50% group, but for needle aponeurotomy patients it happens much sooner.

In 2011 the partial fasciectomy is still the most common surgery for Dupuytren contracture.  In this operation the diseased tissue is completely removed and perhaps parts of the palmar aponeurosis might also be excised.  In 1990 McGrouther reported after this kind of surgery anywhere from 2 to 63% of surgery patients will have their Dupuytren tissue changes  reappear, while in 2007 Schwartz reported 44% recurrence after these same surgeries.

MedScape News Today reported in February of 2011 that contracture recurrence rates range from 27% to 80% after palmar fasciectomy (open hand surgery), and are highest  when this technique is used on  the PIP joints of the fingers. This same Medscape commentary reported 65% to 85% contracture problems recur after palmar fasciotomy (needle aponeurotomy).

Little information for laypeople about Dupuytrens returning after hand surgery

Many patients research on the web or elsewhere for information about Dupuytren contracture surgery.  Usually they find little information explaining that the palmar nodes and cords often   reappear a few years, sometimes as soon as one year, after surgery.  While attempting to learn about Dupuytren surgery from a medical website – and recurrence in particular – the reader will often encounter only a single sentence that mentions the word “return” or “recurrence,” with rarely any discussion or statistics to explain the scope or frequency of the problem.  A large medical website promoting palmar fasciectomy or needle aponeurotomy might only comment, “After surgery, a therapy program of massage, wound care, exercises and night time splinting is important to get the best possible result and prevent recurrence.”

While it can be said that such a website does inform people about the possible return of Dupuytren contracture after surgery, the usual mention is so vague and casually presented that a potential surgical patient will not understand the rather high rate at which the nodules and cords come back after being surgically removed.  With limited information being the norm it is difficult for anyone to develop a clear understanding of how often, how quickly, and how problematic is this return of the Dupuytren’s contracture problem after undergoing a surgical release of the constricted fingers.

It is almost as though the popular medical information sources are reluctant to reveal that while Dupuytren surgery can improve the palm and finger contractures for the short term, the results are somewhat temporary and have no beneficial effect on the eventual progression of the disease.

This would explain why over the years the majority of people I encounter through the Dupuytren Contracture Institute are completely surprised and unprepared when they have a reappearance of their hand contractures after surgery; most thought that once they had the  hand operation their problem was solved and would not come back again.  Over and over I learn these people were not told about Dupuytren’s recurrence by their surgeon, or that the idea of needing a second operation was presented as a genuine rarity.  It is a serious problem when patients cannot provide informed consent for their hand surgery because they have not been given adequate information about the post-surgical return of Dupuytren nodules and cords.

Final comment, Dupuytren reappearance after hand surgery

In 1964 Weckesser stated. “In general, the longer the follow-up period [after Dupuytren’s disease surgery], the lower the percentage of good results.”  This means, of course, that surgery for Dupuytren’s contracture does not stop the disease process or prevent its return, but only provides a temporary break from the contractures. This would not be too bad if the time between surgeries was longer or if side effects, or complications from surgery did not make the problem worse for some patients over time.

Better to avoid the first hand surgery if possible.

Comments

8 Responses to “Can Dupuytren contracture recur after I have hand surgery?”
  1. Kevin Town says:

    I have Dupuytren’s contracture on both hands, as well as Plantar Fibroma (Ledderhose) on my feet. I have chosen to take the surgical route as nothing really works anyway, I just feel it’s best to remove it altogether. I have decided, however, that if this Disease Contracture chronically persists, I have made up my mind to have the hands, or feet amputated to eliminate the problem once and for all. I have never heard of anyone going this route, but then again, most people fear surgery, whereas I don’t. I guess I will be the first to go to this extreme, but when it’s over, I plan to write a in depth testimonial of my experience in order to help others who may, or may not consider this extreme method to rid themselves of Dupuytren’s contracture once and for all.

  2. Dr.Herazy says:

    Greetings Kevin,

    Sorry to hear that your thinking has taken you in this direction. There are conservative measures that can be used to try to get the body to heal Dupuytren’s contracture and Ledderhose disease. Before resorting to such extreme measures I would hope that you first do something less drastic. Please read the Dupuytren’s Contracture Institute website to learn how this can be done.

    Actually, you are incorrect about amputation not being done for Dupuytren’s contracture or Ledderhose disease. In both conditions there is a long and somewhat frequent history of amputation being used in extreme cases. The difference in what I think you contemplate is that medical amputation for Dupuytren’s contracture and Ledderhose disease is often times partial, and it is done only after previous hand or foot surgery has been so terribly unsuccessful or has been done so many times that partial or total amputation is the only reasonable course left available. Your comment makes it sound like you want to remove the offending body part early so that it does not have an opportunity to be a continual problem to you. Lastly, I doubt that you could find a competent surgeon to agree to amputate your Dupuytren’s contracture or Ledderhose disease extremity since this would be an inappropriate and extreme initial treatment approach. TRH

  3. Fernando da Silva says:

    I have Dupuytren’s contracture on both hands. My doctor told me that at at my age there is no recurrence possibility after open hand surgery. I am 66 now.

  4. Dr.Herazy says:

    Greetings Fernando,

    Let me give you my opinion about Dupuytren’s contracture recurrence. Your doctor has the advantage of knowing you directly and personally examining you. I do not have that advantage. It is impossible for me to address your specific situation; I can only speak in broad and general terms about how Dupuytren’s contracture responds to the kind of surgery that is done for most people. After thinking about my response you can make up your own mind.

    Based on my work and my investigation in Dupuytren’s contracture since 2002 I find that approximately 50% of people who have open hand surgery will have some degree of recurrence (early or advanced) in three years. I believe most sources of Dupuytren’s contracture information will generally agree with that number. Further, I find there are extremes for the speed of Dupuytren’s contracture recurrence at both ends: At one end, 5-10% of people will have slow recurrence in 10-15 years, and at the other end, 5-10% of people will have fast recurrence in a year or so. Concerning these fast recurrences, I have communicated with loads of people whose Dupuytren’s contracture recurred in less than a year after their hand surgery. It is my observation that most people’s Dupuytren’s contracture will begin to recur after open hand surgery in 2-8 years.

    Bear in mind that Dupuytren’s contracture recurrence after surgery will always be faster than the speed of development of Dupuytren’s contracture when it progressed prior to surgery. By this I mean that a first time case of Dupuytren’s contracture might take 3-10 years to be severe enough for surgery, while a recurrence of Dupuytren’s contracture to surgery will be faster than the 3-10 years of the original problem; if it took six years for the first episode of Dupuytren’s contracture to get bad enough for surgery, the recurrence of that Dupuytren’s contracture will be 1-5 years; if it took three years for the first episode of Dupuytren’s contracture to get bad enough for surgery, the recurrence of that Dupuytren’s contracture will be 1-2 years. And if you have that 2nd Dupuytren’s contracture surgery, the recurrence after it will be even faster than the 1st recurrence; it tends to continue accelerating and worsening until no more surgery can be done.

    Dupuytren’s contracture recurrence rate or speed it returns after surgery is greatly influenced by the technique and skill of the surgeon. If the surgeon has the hands of an angel and the brain of Einstein the rate will be much lower than if the surgeon is lazy, clumsy and indifferent (they do exist). This is why it is so critically important that you do your homework to find the very best surgeon available to you. You must determine if the surgeon who spoke to you is a gifted genius who knows all his cases have exceptionally low Dupuytren’s contracture recurrence rates, or if he is not being honest with you. You said that your surgeon told you “there is no recurrence possible after open hand surgery.” That is interesting. Ask him to put that in writing.

    I offer for your consideration that there is a way, in some cases, not all, to use Alt Med to assist the body to reduce the Dupuytren’s contracture tissue naturally. From my experience I have found that the harder a person works and the broader the treatment base that is applied, the better the results tend to be. Please review the information on this website to see if you might want to try to possibly avoid the need for hand surgery. TRH

  5. Susan says:

    I had surgery on the Dupuytren’s contracture of my left pinky back on June 10, 2015. It was a complete waste of time, money and pain.

    I first noticed signs of Dupuytren’s contracture less than two years before. It started with a nodule on my palm below the pinky joint. Within a few months I would occasionally feel a twinge of pain in my finger and I could tell the finger was beginning to bend. After a year it had gotten worse and was bending more and more. I finally broke down and went to the doctor and was diagnosed with Dupuytren’s contracture and told I needed surgery. The doctor, my family and friends were all surprised how fast my finger bent in such a short time.

    After being diagnosed I was shocked because at the time I was 45 and I’m female. I am not an alcoholic but I do have a drink once or twice a week, I do smoke but only one or two cigarettes a day. I had and was treated for epilepsy in my youth but grew out of it and was taken off the medicine when I was 32. My father’s fingers were curled with Dupuytren’s contracture on both his hands but he never had it checked. Two of my brothers have been told that they have Duypuytren’s but neither of their fingers have contracted as bad as mine did or as fast. Plus they will never have the surgery after seeing what happened to me.

    After almost two years from my surgery my pinky is much much worse. It is numb, swollen, bent even worse and I can not move the tip of the finger at all. I gave up on the therapy. It was not helping, I think it made matters worse, it was expensive and it was painful.

    Less than six month after my surgery two more nodules popped up on my left hand. One below my ring finger and another below my middle finger. I do have occasional twinges of pain from them but not constant. You can clearly see the fibers stretching from the nodule through my hand and up into the middle finger. There is nothing as noticeable for fibers in my ring finger but I can notice that it is not able to stretch as much as before.

    From reading this article about Dupuytren’s contracture recurrence I obviously don’t want to have additional hand surgery or even to have the shots. Is there anything else I can do? Who should I talk to? If I see another hand surgeon they will just want to cut me open again.

  6. Dr.Herazy says:

    Greetings Susan,

    What a sad story, especially when you consider how frequent are outcomes like yours after Dupuytren’s contracture surgery. Sure, there are some good outcomes. But outcomes such as yours are suppressed and ignored so doctors can propose surgery to patients without objection, just as you did. The medical profession does not have much more than a surgical option for Dupuytren’s contracture, either open surgery or the semi-surgery of closed Xiaflex injection, both of which are riddled with recurrence and side effects.

    You ask if there is anything else you can do for your Dupuytren’s contracture. Yes, I think you should consider 3-4 months of aggressive self-treatment using Alt Med in a way that is intended to increase your body’s ability to remove the fibrous nodule and cord tissue in your hands. Of course, nothing can be guaranteed; nothing in medicine can be guaranteed. After doing this work with Dupuytren’s contracture from all over the world since 2002, I can tell you that for every 8-10 reports of success (ranging from moderate to complete recovery) I receive, there is one report of failure; that indicates a rather good success rate. Perhaps most importantly, I can also report that during this time I have not received one report of recurrence of those Dupuytren’s contracture problems that were eliminated. This is a significant finding, because surgical intervention is marked by recurrence of Dupuytren’s contracture in 50% of cases within 6 years of surgery; at least 10-15% have recurrence of Dupuytren’s contracture within a year of surgery.

    Please review the information found on this website about the natural treatment of Dupuytren’s contracture. Any treatment products you order come with complete instructions for their use; no one complains that they do not know how to use what they order to treat their Dupuytren’s contracture. If you have any questions please let me know. TRH

  7. Andy B says:

    Hello,

    I am from Yorkshire in the UK – with a strong Viking gene running through my family. In June 2016 I had an open fasciectomy for Dupuytren’s contracture on my right hand little finger. The surgery seemed good, with almost perfect results. However within 6 months the lumps came back and now after 11 months I am back to square one with what seems to be more and bigger lumps and a finger that is contracting fast. It seems that the disease is ever so more aggressive post surgery – and I am wondering if it worth having further surgery to correct.

    I do not smoke, I drink on a weekend and I have no family history of Dupuytren’s contracture.

    I want to avoid further surgery and would like to know if there are any other options that I could take ?

    Any help appreciated,

    Andy

  8. Dr.Herazy says:

    Greetings Andy B,

    Sorry to hear about your disappointing Dupuytren’s contracture surgery outcome. Unfortunately, your commentary is familiar.

    Throughout the DCI site you can read reference to the common and inevitable recurrence of Dupuytren’s contracture after surgery of any kind, even Xiaflex injection. From my experience, the pattern is for the Dupuytren’s contracture nodule and cord to increase or worsen in regard to speed and extent of fibrous tissue development after each surgery – recurrence worsens each time the Dupuytren’s contracture is cut. This happens because of the underlying nature of Dupuytren’s contracture to develop excessive fibrous tissue when the palm is disturbed. Hand surgery simply stimulates more dense fibrous tissue to be laid down.

    Most people stop after the second hand surgery when they realize it does nothing to solve their Dupuytren’s contracture; the more you do the worse it gets. I have communicated with many misdirected souls who had to accept amputation as their last resort due to horrendous results after several hand surgeries.

    Based on what others report, it is likely your surgeon did not adequately inform you about recurrence of Dupuytren’s contracture after any type of surgical intervention. If it was mentioned it was down-played as a minor and unlikely or rare occurrence. Most surgeons do not mention the rate and intensity of recurrence because it would not be good for their business.

    You ask about options. Please spend some time reading the Dupuytren’s Contracture Institute website for information about using Alt Med to assist your body’s ability to manage this fibrous tissue problem. While doing this work since 2002 we have collected statistics that are encouraging: For every 8-10 people who report success (moderate to great), only one person reports failure, when our protocol is used aggressively and as suggested. Most importantly, in regard to recurrence, during this same time no one has reported recurrence of their Dupuytren’s contracture after successful non-surgical treatment with Alt Med.

    Please let me know if you have any questions about how we approach Dupuytren’s contracture treatment without surgery. TRH

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