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.

Why is Xiaflex not indicated for palmar nodules?

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 and Recurrence of Hand Contracture

Dupuytren surgical treatment temporary relief

After speaking to well over a thousand people about their Dupuytren surgery options, fewer than a handful knew that surgical repair is only a temporary relief of the palm nodules and finger contractures. Only a few knew surgery for Dupuytrens is NOT a one-time and permanent solution.

Recurrence of a second episode of Dupuytren contracture after the first surgery takes approximately five years, sometimes sooner and  sometimes later.  For every example where someone might have a recurrence after as long as ten years, there are many others who have a return in one or two years; five years is a good average.

Here are important ideas to have in mind when you think about having any kind of Dupuytren surgery:

  1. Once you have your first Dupuytren surgery, you will have others because the problem will return.
  2. There is no such thing as cutting the Dupuytrens tissue out and being done with it.  Some surgeon’s refer to cutting out a large and deep mass of tissue as creating a  “firewall of tissue” to keep the problem from returning, but it is only a delay technique.  It will always return; it is just a matter of time.
  3. If you have Dupuytren surgery and your problem recurs in (let’s say) three years, if you have another or second surgery for the first recurrence of the problem your second recurrence will happen in less than three years.   After each Dupuytren surgery the next recurrence happens faster each time.  The return of your hand contracture will be faster after the second surgery, even faster after the third surgery, and even after the fourth surgery, and so on.
  4. After each hand surgery your 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 each time you have Dupuytren surgery.
  5. 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).

Here is a brief explanation of the different types of Dupuytren surgery and how each rates in terms of recurrence after the first surgery.

  • Regional Fasciectomy: Most common Dupuytren surgery.  The contracted fascia of the palm and involved fingers are surgically removed, requiring general anesthesia or a nerve block.  Requires extended rehabilitation and wound care. Recurrence of Dupuytren contracture – 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 is not removed.  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 – and almost faddish – in-office procedure.  While needle aponeurotomy is a minimally invasive Dupuytren surgery in which a needle is inserted and slashed around under the skin of the palm to shred, lacerate and weakened the Dupuytren cords.  After being so weakened, each cord is broken by hyperextending or pulling each finger straight.  Only local anesthesia is needed.  Requires short rehabilitation and minimal wound care.  Recurrence is about average.
  • Collagenase injection: Early in 2010 the US Food and Drug Administration (FDA) approved inject able collagenase extracted from the bacteria Clostridium histolyticum 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.

None of these surgical procedures has proved to be a way to stop or cure Dupuytren contracture permanently.  It is said that if a patient lives long enough, the finger contractures and palm lumps will return and additional Dupuytren surgery will be needed.

In extreme cases, amputation of fingers may be needed for severe or recurrent disease, or after complications in surgery.

Alternative therapies, such as advocated by Dupuytren Contracture Institute, have received almost no evidence-based research by the large pharmaceutical companies or university medical programs because of their limited profit potential and easy access by laypeople, and so have little support from the medical profession.

♦    Click here to learn more about natural Dupuytren treatment

Dupuytren Cords

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 4th and 5th fingers.   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.

 

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