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

Posted on September 14, 2012September 14, 2012 by

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 hand – the internal Dupuytren cords – which 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.

Why is Xiaflex not indicated for palmar nodules?

Posted on January 17, 2012 by

Hello,

Why is Xiaflex not indicated for palmar nodules? If it weakens and dissolves the cord, why would it not dissolve a nodule?

Thank you,

RSW

Greetings RSW,

The fact is a Xiaflex injection would weaken and dissolve a palm nodule, but then you would have a hole in the palm of your hand. For this reason Xiaflex is only used to treat Dupuytren cords which are below the surface of the skin.

Of course, with Xiaflex injections the medical profession knows that the Dupuytren cords will return rather quickly, usually just a few years, and more injections would then be used. There are two problems in doing this: 1. No one knows what happens to the body with repeated Xiaflex injections. 2. Each time a person has a Xiaflex injection as a Dupuytrens treatment he or she runs the risk of having the Xiaflex dissolve normal tissue and cause problems greater than having Dupuytren’s contracture. For this reason we strongly suggest that anyone with Dupuytrens contracture first attempts to correct their problem using Alternative Medicine. TRH

Dupuytren Surgery Recurrence of Hand Contracture

Posted on June 17, 2011April 19, 2023 by

Dupuytren surgery recurrence means only temporary relief

After speaking to well over a thousand people about their Dupuytren surgery recurrence history, DCI has found something amazing. Just a handful knew hand surgery offers only temporary relief from the finger contractures before their surgery. Most people did not know about Dupuytren surgery recurrence. They thought hand surgery for Dupuytren was a one-time and permanent solution.

Recurrence of a second episode of Dupuytren contracture after the first surgery takes, on average 4-5 years, sometimes sooner and sometimes later. For every example, while someone might have a recurrence in ten years, there are many others who have a return in just one or two years; and even a few months in a small percentage of cases.

Natural Dupuytren disease treatment can help

Good news! When people with early Dupuytren’s contracture use the large DCI treatment plan, good things can happen. DCI receives 8-10 reports of moderate to marked improvement, even elimination, of the palm lump when using the DCI large plan, for every one report of failure.

Using conservative self-treatment early before the cord has a chance to thicken and harden can avoid the need for Dupuytren’s surgery.

Most people DCI works with – and helps – are in early stage Dupuytren’s contracture. This is why we encourage those with palm lumps to treat their problem while it is small, soft and less embedded within the normal tissues of the hand. It is not wise to ignore the bumps on the palm. Treat the abnormal thickened tissue while it is still small and more responsive to self-care.

Keep this in mind

Here are important ideas to have in mind when thinking about Dupuytren surgery:

After the first Dupuytren surgery, there is a good chance a person will have more. This is hte nature of Dupuytren’s contracture. To make excess collagen and fibrin and contracture the palm slowly.
There is no such thing as cutting the Dupuytren’s tissue out and solving the hand problem. Some surgeons refer to cutting out a large and deep mass of tissue as creating a “firewall of tissue” to keep the problem from returning. At best, surgery for Dupuytren contracture is only a delay technique. It will always return; it is just a matter of time.
After each Dupuytren surgery the next recurrence happens faster than the last one. For example, if your first-hand surgery has a recurrence in three years, a second surgery will have a faster recurrence – maybe two years. And, another hand surgery would have a faster recurrence, maybe 18 months, and so on. This is why so many people with DC have 2-3-4 hands surgeries. When they quit having hand surgery it is not because they are better; they quit because they are worse, and they learn it is not possible to get ahead of an aggressive case of Dupuytren’s contracture.
After each hand surgery the recovery will be longer and more complicated with greater chance for side effects. Just like the recurrence problem increasing with each surgery, the amount of numbness, stiffness, pain, scar build up, reduced hand and finger movement and general limitation increases with each Dupuytren surgery.
If your hand has been so scarred, and so much tissue removed by prior surgeries, and pain and limited use of the hand develops, a common solution is to amputate the offending finger(s).

Don’t worry about Dupuytren surgery recurrence

There is no need to be concerned about Dupuytren surgery recurrence if you do not need hand surgery.

None of these surgical procedures is a way to stop or cure Dupuytren contracture permanently. At best, the purpose of Dupuytren’s surgery is to increase finger movement to some degree. That movement might be increased a little or greatly, but the increased finger straightening is only temporary before the excess collagen buildup reduces causes the finger to once again curl down and flex into the palm. In extreme cases, amputation of fingers may be needed for severe or recurrent disease, or after complications in surgery.

♦ Click here to learn more about natural Dupuytren treatment

Different types of Dupuytren surgery recurrence evaluation

Regional Fasciectomy: Most common Dupuytren surgery. The contracted palm tissue is surgically removed. Requires general anesthesia or a nerve block. Needs extended rehabilitation and wound care. Recurrence of Dupuytren contracture is somewhat more frequent than after other types of Dupuytren surgery.
Fasciotomy: Less common Dupuytren surgery. Requires single or multiple incisions (usually in a zig-zag pattern) using widespread dissection over the Dupuytren’s cord, but the diseased tissue remains in place. The idea is to open up the offending tissue to relieve pressure and tension in the palm. Also requires general anesthesia or a nerve block. Requires extended rehabilitation and wound care. Recurrence is slightly more frequent than a regional fasiectomy.
Dermofasciectomy: Less common Dupuytren surgery. Surgical removal of diseased skin and fascia overlying Dupuytren cords, in which diseased soft tissue of palm is replaced with a skin graft from patient’s forearm. Requires very long rehabilitation and wound care. Recurrence is somewhat less frequent than regional fasciectomy.
Needle Aponeurotomy (NA): Very popular – almost faddish – in-office procedure. Needle aponeurotomy is a minimally invasive Dupuytren surgery. A needle tip slashes around under the skin of the palm to shred and weaken the Dupuytren cords. Afterward, each cord is broken by hyperextending or pulling each finger straight. Local anesthesia used. Requires short rehabilitation and minimal wound care. Recurrence is average.
Xiaflex (collagenase) injection: In 2010 the US Food and Drug Administration approved injectable Xiaflex to be used in treatment of Dupuytren contracture. Collagenase erodes the Dupuytren cords when they are injected with small amounts of this enzyme, breaking the peptide bonds in the cords of collagen. Recurrence of hand and finger contractures seems to be most frequent with this technique.

Dupuytren Cords

Posted on June 12, 2011 by

Dupuytren cord causes finger contractures

Dupuytren contracture is thought to be primarily a genetic condition that mainly affects men over 50 years of age, with more aggressive forms starting at an earlier age. Women also develop Dupuytren cords, but at a lesser rate until age 80 when the occurrence is about equal to men. The process involves excess collagen material that creates Dupuytren cords in the palm of the hand, most often affecting the 4^th and 5^thfingers. These cords are nodular in two out of three cases, displaying from one to three nodules when present.

Onset occurs as a palm nodule or bump that many assume is only a callus. Gradually, over a few or many months, the Dupuytren cord becomes more prominent and the palmar fascia thickens. As the process continues the overlying skin puckers, dimples, and roughens. The thick cords contract slowly over time, drawing the fingers into the palm and may bring adjacent fingers together. The ring and little finger are most commonly affected and usually are affected first when other fingers are also involved. As is typical of similar conditions in which excess collagen is deposited (Ledderhose disease, Peyronie’s disease, Garrod’s pads) the progression is often erratic, arbitrary, continues in spite of medical treatment, and has no obvious cause.

Dupuytren cords treated with Alternative Medicine

Dupuytren cords are composed of collagen connective tissue right under the skin, in a layer called the palmar fascia. As the Dupuytren contracture progresses the cords begin to thicken and shorten, causing them to develop a wider display of nodules and folds of thick tissue on the surface of the palm. Tightening and shortening of the Dupuytren cords pulls the involved fingers down toward the palm in the characteristic hand posture of Dupuytren contracture.

Dupuytren’s contracture is more likely to be found in those who also have epilepsy (anticonvulsant medications are suspected to be the stimulus), diabetes, alcoholism, HIV, liver cirrhosis, and smoking. Trauma and exposure to chronic hand vibration may also exacerbate this condition.

Needle aponeurotomy or more aggressive surgical intervention are the only current medical methods offered to temporarily alleviate some of the outward appearance of Dupuytren contracture. In spite of having both needle aponeurotomy and surgery, 50% of patients who have either procedure will still experience a recurrence of the palm nodules and Dupuytren cords within two to three years.

There is another option to consider using to slow down or even reduce the size, shape and density of Dupuytren cords. The Dupuytren Contracture Institute has specialized since 2002 in the use of Alternative Medicine therapies and techniques that are found to be successful in perhaps 60-80% of cases of Dupuytrens without risk of worsening or side-effects. Click here for helpful ideas to start a Dupuytren treatment plan with Alternative Medicine.