Would Dupuytren contracture massage be helpful or aggravate the problem?

I am in the very early stages of this problem and want to know about Dupuytren contracture massage.  My problem started 6 months ago and want to try to turn this around sooner than later…. Not sure I can afford or even want to take everything on your plans….so if you could list out the TOP 6 supplements to take, could you let me know…?  Would 6 even be enough?

Do you think massage helps Dupuytrens contracture? Or would it aggravate it?

I have one other question…..lets say I get the most expensive plan as well as the most expensive enzyme you sell…which would be a ton of money to maintain over the months….and I do get positive results…what is to stop it from coming back again like it might after surgery? I want to get to the UNDERLYING cause of this rather than treating the symptoms. I know some say it is genetic but I am wondering about diet etc. It makes no sense to spend thousands on supplements which it could end up costing that for the body to re absorb the tissue, which I believe the body is capable of doing…only to have it come back again…..

Regards, Catherine

 

Greetings Catherine,

Your thoughtful questions bring up many broad and interesting topics to explore that I believe will not only help you, but others as well.

The first point is that you do not need  to “take everything” found in the DCI plans.  These various plans are well rounded and balanced examples of what a person might need to use to enhance their healing ability against the foreign fibrous tissue of Dupuytren’s contracture.  No one knows what you might need to make this happen, or even if it will happen.  The idea is to do as much, and to take as much of a variety of nutrients, as you think reasonable and appropriate to get the job done.   The problem is that no one knows what you will need to get the job done.  Because of this DCI recommends that you use a broad and diverse array of possible therapies, while monitoring the size, shape, density, surface features and degree of adhesion of the deep and superficial fibrous tissue in your hand plus the range of motion of the involved fingers, to determine the effectiveness of the therapy you are using.

As a second point, there are no top six therapies in terms of those that are most effective because the therapies are not used this way.  They are all used in groups and combinations, and it is never recommended that any one therapy be used by itself as a solo therapy.   Besides, if I could give you a top six list it would not mean that they would necessarily help you.  What works for one person will not necessarily work for the next person in the same way.

Dupuytren contracture massage

Thirdly, Dupuytren contracture massage can be helpful, but extreme caution and care must be followed.  I have seen internet discussions in which people have recommended deep and forceful pushing and gouging of the internal fibrous tissue to “break it up.”  This is a mistake that can lead to aggravation and spreading of of the initial problem.   The best kind of soft tissue work is extremely light and passive manual stretching – so light that while you are doing it you think that it is too light to be effective.  Dupuytren contracture massage must be done with grave caution since it can easily be misused, and you only realize you have overdone it when it is too late

Lastly, you ask about recurrence of Dupuytren contracture after DCI treatment.  Dupuytren recurrence is a constant problem that has plagued surgeons for centuries and even to today.    Please see Dupuytren Surgery and Recurrence of Hand Contracture.   Even so, in almost 12 years of doing this work of helping people to deal with their hand contracture using Alternative Medicine I have never had the occasion of someone coming back who got good results to say that their problem recurred after using the DCI concepts of treatment.  Perhaps there is someone out there who had their DC return, you never know, but no one has told me so.  I suppose it is possible, but I have no knowledge of it.

Even if the DC did recur after DCI style treatment, the consequences would be far different than if the DC did recur after hand surgery.  When a hand is operated on for Dupuytrens, normal healthy tissue is removed along with the diseased tissue.  As a result of that hand surgery the hand is vastly different than it was before surgery; it has been diminished and is less structurally strong; not only are some tissues now missing, many are shortened and altered by the surgeon.   When –not if – Dupuytren contracture recurs after the first hand surgery, the next surgeon will have less tissue to work with for the second hand surgery.  If the second hand surgery is done then the next recurrence will be all the more difficult for the third hand surgery.  For this reason many people find that after the 2nd or 3rd surgery – and sometimes even after the 1st surgery – that no more surgeries can be performed.  These people face the possibility of either allowing the hand to develop full blown contracture or amputation.

All I can tell you is that it makes most sense to me to be as conservative as possible and to try as many non-surgical options as make sense to you before submitting to DC surgery.   I am not against DC hand surgery, just very conservative about its use because of the dire results I encounter on an almost daily basis.

If I can help you in any way please let me know.  TRH

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

 

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.

Any advice for other fingers after a bad Xiaflex procedure for the first finger?

I just had the Xiaflex procedure done on my pinky finger and it was an extremely painful procedure I must say. The way it was done was that on the first day the doctor injected the Xiaflex at the base of my pinky finger. Within two hours the entire area was extremely swollen and painful. The following day the doctor did what he called “the manipulation” part of the procedure. I had the already extremely swollen and tender area of my pinky shot up with lidocaine injections which was very painful in and of itself. Then the doctor started wrenching the pinky back and forth so forcefully that I about passed out. He reluctantly injected more lidocaine (on my request) and came back 30 minutes later. He again wrenched the pinky so hard back and forth that I almost passed out, and had to sit with my head between my legs to keep from passing out when he was done. As a result of wrenching my pinky so hard I developed a large blood blister at the base of my pinky, which was extremely painful and took almost two weeks to finally go away. The area is still peeling skin and rather swollen and dark pink. Is this a typical procedure for Xiaflex? What I mean is it typical for this “manipulation” of an already tender and swollen finger? I am not feeling like I do not want to go through this again on other fingers which are crooked. Please advise!

 

Greetings,

A few thoughts come to mind based on what you related about your experience with the Xiaflex procedure for Dupuytren’s contracture:

1.  What your doctor called “the manipulation” is a standard part of the usual Xiaflex injection procedure in which the Dupuytren cord is manually broken or snapped in half after it has first been weakened by injection of the collagenase enzymes in Xiaflex.  It is how the procedure is done.  First the cord is weakened and the next day it is broken by forcefully bending and extending the involved finger.

2.  Based upon what you have described, I get the impression that the doctor who did your injection did not do a good job of injecting the enzyme into the cord to weaken it.  Either he did not inject enough of the enzyme into the cord, or he missed the target tissue.  Usually the procedure is not as abusive or painful as what you have described.

3.   Based on what you have described, I get the impression that your doctor did not adequately explain ahead of time what he was going to do or what you would experience.  This is unfortunate.  Without this information you could not make an informed decision about the procedure.

4.  I wonder if you are aware that after going through the painful and prolonged Xiaflex procedure that it is just a matter of time before your Dupuytren’s contracture will recur in that same finger.  Please read my post, “Do Xiaflex injections really have a low recurrence rate?”   In this post you can read about the Dupuytren finger contracture coming back over a period of time.   Based on the way you were not told about what might happen during the Xiaflex procedure I hope you were at least told that that the Dupuytren’s contracture will always come back after any surgical intervention, and yes, a Xiaflex injection is a surgical intervention.  If your doctor says it is not, ask him for a few bottles of Xiaflex to take home because you want to inject some Xiaflex in a neighbor’s hand.  Of course, he will not give any to you because you would be doing surgery and he cannot be a part of that.       

5.  I wonder how much experience your doctor had doing Xiaflex injections?

6.  I suggest that you spend some time on the DCI website to investigate the possibility of  using Alternative Medicine for a few months to see if you can support and increase your ability to remove the Dupuytren contracture material in a more conservative manner.   There is no easy way to get rid of Dupuytren’s contracture, as you have already seen after using the “miracle” procedure with Xiaflex.  Yes, it might get rid of the Dupuytren cord without surgery, but it has the potential for serious side effects and the benefits are only temporary.  I suggest you look into trying to rid yourself of the lumps and cords in your hands without risky surgery.  TRH

How are the Dupuytren contracture therapy products used?

Hi Dr Herazy. I have Dupuytren contracture on both hands. I had surgery to cut the contracture and my Dr applied a Digit Widget on my right ring finger. Once my finger gets straighter I will then have surgery to remove all of the cording. I am very interested in your treatment plan to hopefully eliminate the need for that surgery. Which plan do you recommend and how are the products used? Are they all applied topically? Thanks – I’m looking forward to your response. Regards, Vee Cluley.

 

Greetings Vee,

You are wise to want to avoid Dupuytren’s surgery since none of the operations will cure the problem, and the hand contracture will always come back in a few years.

I always recommend that a person uses the most aggressive plan they can afford, since the more variety and depth of therapy that is used offers greater opportunity for improvement.  The Dupuytren medium plan is the most popular, but the large plan gets best results.  The greatest cost difference is just getting started, and after that the medium plan averages about $90-105/month to continue and the large plan averages $95-110/month to continue. 

Full instructions come with the order that you place; whatever you order we include detailed instructions to use all items so you are comfortable you know what to do. 

Some items are applied topically (DMSO, vitamin E oil and Copper peptide, Genesen pens) while the others are taken orally. 

Let me know if I can help you in any way.  TRH    

Next Page »