Dear Dr. Herazy,
My father has been diagnosed with Dupuytren’s some months ago, but only recently has complained about any pain. The pain is not unbearable, it is just a feeling to remind him that it’s there. So nothing big at the moment.
He wants to treat it, but he has asked me to investigate on when is the best time to have the surgery? His hand is still in the early stages of the contracture. Should he have the surgery as early as possible, or is it better to wait until his fingers are contracted more?
I must commend you on being a good daughter to help her father in this way.
You must remember that this site is devoted to the non-drug and non-surgical treatment of Dupuytren contracture. There are those cases that probably should undergo Dupuytren’s surgery, but in the opinion of DCI surgery for someone like your father should only be done after more conservative measures have failed to improve his situation.
Usually Dupuytren contracture is not painful, except during the early stages and then only for a limited time. Many of the cases whose hand pain persists and undergo our Alternative Medicine self-care report rather rapid and complete elimination of pain. If it is only pain relief that your father is interested in, he should not be overly concerned since this usually is self-limited after a short while. this process of pain relief is something that responds to well with our treatment measures.
Since Dupuytrens will return after all forms of hand surgery, given on average about five years, your father should understand that Dupuytren surgery is not an absolute final treatment for anyone. Typically, after the first surgery when the problem recurs it is a little worse and returns a little sooner after each surgery that is done
An orthopedic surgeon who works with Dupuytren cases will usually decide when and how to perform surgery on the hand based on several factors:
1. Age of the individual
2. Duration of DC
3. Severity of involvement
4. Degree of limitation of use
5. Degree of reduction of quality of life
6. Family history of DC
7. History of past injury and surgery to hand
While no specific rules exist that determine when Dupuytren surgery should be done, many surgeons recommend when the large knuckle of the involved finger reaches 30 degrees of flexion contracture. When the problem returns after surgery or causes more severe contractures after the surgery heals, fusion of the individual finger joints is sometimes recommended. In the worst case, finger amputation of the finger is recommended if the developing contracture restricts the blood or nerve supply to the finger. TRH