Tag Archives: dupuytren hand surgery

My Dupuytren’s surgery lately is going badly; do you have any suggestions for me?

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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?

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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.