Tag Archives: dupuytren recurrence

My 25 year-old son has Dupuytren’s contracture. What treatment would you recommend?

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Hi Dr. Herazy,
I came across your website while searching for more information on Dupuytren Contracture. My son had intricate surgery on his finger in June and recently noticed a small lump on the palm of his hand. It’s not painful, but the doctor said it looked like Dupuytren Disease. He is only 25 years old and I am very concerned about the future. Have you seen this before in someone his age and can he stop the progression of this disease with your products? What treatment would you recommend for someone his age? There also may be a predisposition to this as I have a painful lump on the bottom of my foot that I will be checking out with a doctor. Thank you very much.
PG

 

Greetings PG,

You are a good parent.  Once a parent, always a parent.  My youngest one of three is soon to be 38, so I know how this goes.

My guess is that you have a genetic predisposition to this excessive fibrous tissue response that your son has inherited from you.  This is made even more so if both you and your husband/wife are also genetically predisposed with families coming from Northern Europe or Scandinavia.  If this is true it would explain why some one who is so young has developed this problem.  Perhaps your son has unknowingly made himself susceptible with other factors that increase the odds for Dupuytrens:  diabetes, cigarette smoking, alcoholism, and prolonged hand stress  like with manual labor.  I also notice that many serious musicians who play piano or guitar seem to develop DC more than the average population.  Any of these might explain this problem developing so early in his life. 

I have seen this before in people in their mid-20s and it is usually accompanied by factors as I have explored above.

I would recommend the largest and most aggressive treatment he can sustain for at least 3-4 months of faithful and diligent work.   If this problem is to respond at all to Alternative Medicine methods the treatment approach must be significant to make an impact on his condition.  Please read Can I treat Dupuytren’s contracture naturally without surgery or drugs?       Dupuytrens is a tough problem.  Half efforts are usually a waste of time.  Allow me to explain why I think someone such as your son should be extremely interested – far more than most all other people – in avoiding surgery and getting natural conservative treatment to increase his ability to eliminate his hand nodule.  

Hand surgery for Dupuytren’s contracture is not a cure; any good surgeon will tell you that needle aponeurotomy, palmar fasciectomy or Xiaflex injection are just a temporary measure; the Dupuytren’s contracture problem will always recur – it is a matter of when the recurrence will develop, not if.  When someone in his 60s or 70s develops DC and has surgery, the Dupuytren recurrence factor is not as important because frankly at that age this person might not live long enough to develop the recurrence and have it evolve over a few years to the point that a second surgery is important to them.  Many elderly people get their first DC surgery and just ride out the effects of the recurrence as they try to ignore a growing hand problem.  But with a 25 year old person all of this strategy is changed.

A young person has a lifetime to not only develop one recurrence of Dupuytren contracture, but several or many.   Some people can have a recurrence in just just 2-3-4 years and a few have recurrence in a year or less.  With each surgery recurrence usually is made to come more quickly; with each hand surgery the rate of recurrence increases.  It is as though the irritation and instability created by the surgery speeds up the recurrence phenomenon.    Many times after a few surgeries are done it does happen that eventually amputation is the only viable option that remains. 

With someone in his mid-20s this can be a great problem, since there are so many wonderful years that lay ahead.   For this reason it is my opinion your son should do absolutely everything possible to avoid entering upon this slippery slope.  I suggest that your son start as soon as possible to see if he can increase his natural ability to remove this foreign fibrous palm lump.  As with anything in healthcare (like Dupuytren’s hand surgery) there are no guarantees this will work, but when you consider the fact that his approach is without side effects, that in almost 11 years we have not had one report of recurrence after successful treatment, and that surgery can also be used at a later time if  necessary.

I suggest he does some reading on the DCI site to learn how this approach is done.  Let me know if you have any questions.  TRH

Is the DCI treatment for Dupuytren contracture a lifetime correction?

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i saw a dr. yesterday.   he wants to use the needle procedure xiaflex.  after reading DCI information on your website i’m not sure which way to go.  if i use the alternative method is it a lifetime treatment?
Greetings,

Good question. 

At this time we have been working with people for only 10 years using Alternative Medicine treatment of Dupuytren contracture.  During that time DCI has helped many hundreds of people from around the world improve and overcome their hand contracture problem.  And during that time I have not had anyone come back later to say their Dupuytren contracture returned – no one .    This either means that people have had their DC come back but they have not told me about it, or it means that their DC has not returned.  I cannot say for certainty which it is because we are not capable of doing follow up studies at this time of those people who report improvement of their hand problem.

Injection with Xiaflex to treat Dupuytrens is not perfect; there are inherent risks and problems that occur.  While the rate of Dupuytren recurrence after Xiaflex injections is less than after surgery, the hand problem does recur.   The makers of Xiaflex hold this finding up to indicate that this means the recurrence rate is low.  I think the Xiaflex rate of Dupuytren recurrence is not actually low; it is just not as high as after surgery.   Because these injections only make temporary changes to the hand at the specific site of drug action, you will eventually have to do the Xiaflex injections again and again.  Actually what they are finding out is that the rate of recurrence of Dupuytren contracture after Xiaflex injections will increase each time you have the injections.  This means that the more you use Xiaflex for your hand, the faster it will come back.   Each time you use Xiaflex you expose yourself to the risk of accidents and drug reactions in which blood vessels, tendons, nerves, and muscles can be permanently damaged.  For more information please read, “What is Xiaflex and what are the risks if I take it?” and “Do Xiaflex injections really have a low recurrence rate?“

I cannot tell you what you should do.  But I can tell you that you should spend some time learning the pros and cons of this new procedure and fully understand what it is all about.  As a suggestion, you should consider trying a brief therapeutic trial of Alternative Medicine treatment, perhaps for a month or two,  such as you see on the DCI website to see if you can respond favorably to conservative care.  If it helps you as it has helped many others, you might not have to consider any drug or surgical treatment.  If it does not help you, you can go into a drug or surgical treatment knowing that you have tried to be conservative first and now you are ready for more radical treatment.   TRH

What should father do about rapid Dupuytren recurrence and weakness after hand surgery?

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My father had Dupuytren surgery (he would not have gone through with it had we read about your site beforehand) and he has lost a significant amount of strength in his hand and his pinky finger is already starting to bend again only three months after his surgery in November!   Is there anything you can recommend to help him regain strength and slow down progression of it happening again?     Thank you!

Greetings,

Open-hand surgery for palm lumps and cords has a fairly fast rate of Dupuytren recurrence, so I will assume this is the type of surgery he had.  With his three month reappearance of finger flexion he must must be terribly discouraged.   Many people at this point are advised by the same surgeon that another operation should be done to improve the results of the first surgery.

I advise that your father thinks long and hard about the wisdom of multiple surgeries to accomplish the elusive “surgical correction” for DC.   From my experience while collecting reports from people around the world, people who have rapid Dupuytrens recurrence (fingers flexing toward the palm again, return of palm nodules and cords) or otherwise poor results (pain, finger and hand numbness, coldness and weakness) after hand surgery will find that additional surgeries will usually only lead to an even worse outcome, not a better outcome.   If he is at all considering additional hand surgery he should get a second opinion from the best hand surgeon he can find, preferably from someone who is located far outside the area where he lives.  This is a good idea because if you get a second opinion from someone local it will tend to be less honest and objective.

By following a good upper body and hand exercise program, and using a varied Alternative Medicine treatment plan such as you see on the DCI website, it might be possible for your father to support and enhance his ability to reverse some of contracted tissue.  There is no way to know for sure if this will work for him, especially since he has had one hand surgery.  But I do hear from DCI readers who report variable improvement with these conservative methods.  It is my opinion it is worth the time and effort to see if it can slow down the progression and perhaps even reverse some of the tissue changes.  TRH

Do Xiaflex injections really have a low Dupuytren recurrence rate?

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What does “recurrence rate for Dupuytren contracture” mean? 

Dupuytren contracture is famous for the fact that in about half of the cases the problem returns about five years after hand surgery. For some people the reappearance is as soon as one year after an invasive operation to remove the cords, nodules and contracted hand tissue.  Many people are disheartened to learn that surgery and Xiaflex injections are not a final answer to their hand problem because of Dupuytren recurrence.

Consider a brief delay of Xiaflex injections to see if natural remedies might help

The Dupuytren Contracture Institute is not against Xiaflex injections or surgery for Dupuytren’s contracture.  Since 2002 our position has always been to recommend surgical intervention in those cases that have not responded to an aggressively applied round of conservative Alternative Medicine therapy.  If a brief therapeutic trial of natural Alternative Medicine treatment has limited results, we then advise to have an evaluation from two doctors who specialize in Dupuytren’s contracture for possible surgical or Xiaflex intervention.

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However, there are those who approach the management of their Dupuytren contracture in the reverse order:  They first have hand surgery for their Dupuytren’s problem and only after the problem recurs do they consider conservative treatment.

People from around the world report they rushed into having a hand operation, not knowing of the possible side effects and recurrence issues that develop after invading the area of Dupuytren’s disease. It is DCI‘s opinion that it is safe and reasonable to attempt to improve the body’s ability to heal and repair the problem of Dupuytrens contracture by aggressively using several conservative Alternative Medicine treatment measures for a short time.  We strongly suggest that anyone with Dupuytren contracture works with what is known and what is available – even if it is not perfect – before submitting to potentially risky surgery.  If DCI’s conservative concepts do not improve or eliminate the hand lump, Dupuytren’s surgery can always be done later.

How low is the Dupuytren recurrence rate after Xiaflex treatment?

Auxilium Pharmaceutical, manufacturer of Xiaflex collagenase injections, boasts that in a two-year study Xiaflex had a recurrence rate of 19.3 percent, a considerably lower rate of return than those who used surgical procedures to treat their hand problem.

The answer to the question “Is the Xiaflex recurrence rate for Dupuytren low?” is a qualified yes and no.

Yes, Xiaflex or collagenase treatment results in a considerably lower Dupuytren recurrence rate than hand surgery.  However, this does not necessarily mean that the rate of recurrence is actually low; it only means the problem will come back slower than what happens after invasive hand surgery. The reality is that hand surgery has a tremendously high recurrence rate, so a non-surgical therapy option by comparison will look favorable.

Every child learns that pointing to someone who has done something worse than you does not diminish his crime.  When you told your mother that the child next door stole 25 cents from his mother, you were trying to make yourself look pretty good for stealing only 10 cents from her purse.  Your mother was not swayed by the faulty logic of a scared child.  In the final analysis, even though the numbers were different, both children did something wrong.

And along a similar line of thought, 19.3% recurrence is still a high rate for Dupuytren contracture to come back after being subjected to an invasive medical procedure that carries risks, even though there are other treatment methods that have a considerably higher rate of recurrence.

Most surgeons will admit that any type of physical invasion into the palm (like with surgery or injections) seems to accelerate the progression of Dupuytren’s disease.  Patients note that their previously slow progressing hand contracture not only recurred after surgery but worsened at a faster rate.

Perhaps a better question to ask is, “Would you want to undergo an invasive medical procedure like a Xiaflex injection series, knowing that 20 out of 100 people will have to do it again in two years?”  The answer should take into account that more injections might not be as simple and uneventful as receiving the first Xiaflex injection.

Xiaflex has a short history of treatment of Dupuytren contracture

Since Xiaflex was given FDA approval for Dupuytren contracture treatment in early 2010, not enough time has lapsed and not enough patients have used this procedure for the FDA to know sure what will happen to those 19.3% of patients who have recurrence within two years after receiving a second – or third or fourth – injection series.

For example, recent research information released about Xiaflex at the three year follow-up shows that 34.8% of joints with initial clinical success experienced recurrence, considerably higher than the 19.3% recurrence rate reported at the two year mark.  It is reasonable to speculate that the Xiaflex recurrence rate will continue to increase at the four and five year follow up marks, bringing Xiaflex recurrence much closer to the frequency of hand surgery.

There are two valid issues to consider about repeated injections with a new drug like Xiaflex:

  1. When Xiaflex is injected to dissolve the collage cord of Dupuytren’s contracture it carries the risk of physician error and unintended drug consequences, such as injection into a nerve or artery, accidental leakage causing destruction of tendons or muscles, or drug side effects.
  2. No one knows the long term consequences of multiple Xiaflex injections over time into the same area. After all, 70% of people who receive their first Xiaflex injections find that the Dupuytren cord does not break as it should; they must return one month later for another series of injections; if this does not work, they again must return in one month later.  The manufacturer does not recommend that anyone receives more than three series of Xiaflex injections if it did not dissolve the cord by that time.  In this way the manufacturer of Xiaflex is admitting there is a reasonable limit to how often and how much this drug can be used for the same cord.

Return of Dupuytren after hand surgery

There are two common types of Dupuytren hand surgery. The first is palmar fasciectomy (cutting the palm open to remove the deep connective tissue of the palm and collagen cords) with a 35% recurrence rate after two years.  The other is needle aponeurotomy or palmar fasciotomy (inserting a needle into the palm and blindly slashing at the Dupuytren cords wit h the tip of that needle) with an 85% recurrence rate after two years.

By comparison, yes, the Xiaflex return rate of 19.3% recurrence at two years is lower than aggressive surgery. However, this recurrence rate for Xiaflex is said to be low only because the recurrence rates for the other types of surgery are so terribly high by comparison.

At the Dupuytren Contracture Institute we take the position that it is better to avoid the risk the hand problem will return after undergoing any kind of hand surgery by first attempting Alternative Medicine natural Dupuytren treatment.

Why not have needle aponeurotomy and avoid all those vitamins?

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Dr. Herazy,

Why should I fool around with all these vitamins and DMSO on my hand if I can just have needle aponeurotomy and get quick results and be done with my problem?  Your ideas seem like a lot of work.

Thanks,

Victoria

Greetings Victoria,

Thank you for your very direct question.

Using the DCI treatment protocol can be work, but you should follow it anyway for a few good reasons.

1.  After having a needle aponeurotomy you are not necessarily “done” with your problem.  Needle aponeurotomy is not a cure for Dupuytren contracture, and after having your first one you could easily need another one – and perhaps another – in a just a short time; sometimes in as little as a year.  Dupuytren contracture is well known as a hand problem that recurs after correctional surgery, and the Dupuytren recurrence rate is the highest and fastest after needle aponeurotomy.

2.  Needle aponeurotomy is surgery, although it is a less complicated type of hand surgery.  Doctors who perform NA like to say it is a non-surgical treatment for Dupuytrens, but when you consider what is involved you will see it is indeed hand surgery.   A doctor must perform this procedure (your barber or butcher cannot do it), sterile technique must be used, cutting and laceration of internal tissue is done, bleeding takes place, bandages and post-surgical drugs are prescribed infection is possible – it is surgery.  The only thing missing is the scalpel, but the same kind of work is done with the tip of a hypodermic needle.   The selling of the idea of doing this kind of surgery is to make it seem like it is not surgery because all surgeries have complications and risks. Most thinking people will go out of their way to avoid the risks and complications of surgery.

3.  Many people have found that once they have their first hand surgery, their Dupuytren contracture is worse the second time it recurs (as they all eventually do) simply because of the scar tissue that develops after having any surgery.  It is my opinion it is a good idea to avoid getting on that surgical merry-go-round if it can be at all avoided.

4.  If you attempt to use natural Alternative Medicine as a Dupuytren treatment for a brief therapeutic trial to see how well your hand  responds, and you are not satisfied, you will still be able to have any kind of hand surgery that is appropriate for you. The opposite cannot be said:  Once you have any kind of surgery, there is no way to undo it.  Once you have been cut on, once scar tissue has developed, once your body has been surgically altered, there is no way to get back to normal.  Because surgery that is done to remove the scar tissue of past surgery often results in more scar tissue – and even less normal tissue – it is much more difficult and less effective to later try to use natural Alternative Medicine methods to reduce your Dupuytren contracture.

Let me know if I can help you in any way to avoid hand surgery and to return your hand to full use.   TRH