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Dupuytren contracture recurrence after hand surgery

Posted on by Dr. Herazy

Recurrence of Dupuytren contracture is commonDupuytren contracture recurrence is the return of excessive collagen and fibrin into the palm after hand surgery.

Dupuytren contracture recurrence means that the abnormal palm and finger tissue comes back after surgical removal. For example, after surgically removing the palm lump, it grows back again.  And, after surgically straightening the bent finger to some degree, the finger cord grows back, pulling the finger down toward the palm again. This happens because this is the nature of Dupuytren disease. Excessive and spontaneous collagen production in the palm of the hand continues because surgery cannot stop it.

Recurrence of Dupuytren contracture after surgery is common and frequent.  This return of the Dupuytren contracture tissue is exactly why some people have 2-4, or more, hand surgeries. They always think the next surgery will solve their problem.

Surgeons admit that “sometimes the Dupuytren contracture returns within a few months after surgery.  Other times, it can return many years – even decades – later.”  It has been written, if a person lives long enough after hand surgery, the Dupuytren tissue will eventually return.

No Dupuytren contracture recurrence with natural treatment

Good news!  Based on reports from customers using the DCI large treatment plan, 8-10 people have moderate to marked reduction of palm lumps and finger cords, for every one who reports no change.  Since 2002, no one has ever reported a recurrence or worsening or side effect after improving their DC with the DCI treatment method.

The purpose of using natural Alternative Medicine treatment is to get that DC tissue healing, thus avoiding the need for any hand surgery. If you can get better on your own, there is no need to worry about Dupuytren contracture recurrence.

The DCI treatment system has saved countless people from needing hand surgery. Their fingers and palms improved enough with the DCI method that they, and their doctors, did not think surgery was still necessary.

Get started with    Dupuytren’s contracture natural treatment 

An old and common surgical problem  

The greatest French surgeon of the 19th century was Guillaume Dupuytren.  Even so, he also had patients whose palm lumps and finger contractures returned after hand surgery. He experimented with a variety of tactics and methods to minimize the return, but none were totally successful. Some things never change.

So, if Dupuytren contracture continues to be a problem during 300 years of surgery, what does that mean?  That they were all bad surgeons?  No, of course not.  Actually, even fantastic surgeons must deal with recurrence of Dupuytren contracture.  Fundamentally, the real problem is that Dupuytren disease is a nasty problem.  After surgery the patient still has Dupuytren disease.  And, of course, this means the patient still has the tendency to produce too much collagen and fibrin – even after surgical removal of the palm lump and finger cord.

Here is the nasty truth about Dupuytren contracture:  There is no way to get rid of it by cutting it out or dissolving it with Xiaflex (collagenase enzyme). It just keeps coming back.

Hand surgery to remove the palm lump and finger cord is like hitting a skunk with a stick to get it out of your garage. Forcing the skunk out just creates more trouble, and you get more of what you are trying to get rid of.

DCI thinks it is smarter and safer to get the skunk to leave quietly, naturally, so it does not cause any more stink.

People tell us about their Dupuytren contracture recurrence  

At DCI, we talk to many people about their Dupuytren problems. As you might suspect, the subject of Dupuytren contracture recurrence is a popular topic. Based on these conversations, we learn the average persons’ Dupuytren recurrence returns 2-3 years after surgery. It is not uncommon for recurrence to start in less than a year; some just a few months after hand surgery.  At the other extreme, other people say their DC took 5-10 years or more to return.

In addition, we discuss the actual condition of the hand when the DC returns. Do not assume that after returning, the Dupuytren problem will be the same as before surgery. Perhaps it might feel good for a few months, or even or year or so.  Eventually, the hand contracture will return. How good or bad the hand becomes depends ultimately on many different factors that are beyond the control of the doctor:

  1. Amount of normal and abnormal superficial and deep tissue that must be removed.
  2. Size of the palm lump and finger removed.
  3. How deeply the palm lump and finger cord has grown into the surrounding normal tissue.
  4. Where the palm lump and finger cord are located in relation to important blood vessels, muscles and nerves.
  5. If skin grafts are necessary to close the incisions, and if they heal well or get infected.

What happens after hand surgery?

After hand surgery, the patient still has Dupuytren disease.  Surgery only removes the thick contracted tissue; the disease remains.  Therefore, the patient’s hand can still produce an excessive amount of collagen and fibrin in that same area of the hand.  When it does, it is called Dupuytren contracture recurrence.

Removal of a large percent of tissue from the palm of the hand has consequences. It often results in a worse situation than before the hand surgery, for several reasons:

  1. Continued scar formation causes the palm to become even thicker and less flexible.
  2. Pain due to scar development after the removal of normal and abnormal tissue during surgery. It can be mild to severe, and occasional to constant.
  3. Numbness and tingling of the fingers and hand due to that same scar development.
  4. Permanence of some degree of finger joint stiffness. Seldom are fingers completely straightened after surgery.  And over time they stay flexed even more than before.
  5. Loss of muscle and valuable connective tissue with each surgery, causes weakness and awkwardness of finger and hand movement.

What is the possibility of recurrence

First of all, there is no way to accurately predict anything about Dupuytren recurrence after surgery. No one can say when recurrence will happen; how severe it might be; or what symptoms might develop.

However, a few statistical indicators suggest recurrence of Dupuytren contracture could happen sooner if one or more of the following is true:

  1. Finger joint flexion fixed at 30 degrees or more.
  2. One or more immediate family members also have DC.
  3. One or more ancestors are from northern Europe or Scandinavia.
  4. Younger than 60 years of age at onset of DC.
  5. Palm lump and finger cord are developing rapidly.
  6. History of diabetes or liver disease.

Final comment

In 1964 Weckesser stated, “In general, the longer the follow-up period [after Dupuytren’s disease surgery], the lower the percentage of good results.” This means that shortly after surgery the hand can feel and look pretty good.  However, as weeks and months pass, it is very common for the hand to tighten up again.  The results and benefits that looked so promising at first, fade and worsen. This return of the contracture ultimately causes more pain, numbness, weakness and other related problems.

Surgery for Dupuytren’s contracture only provides a temporary break from the contractures and other related complaints. The recurrence of Dupuytren contracture might not be too bad if the time of relief was long enough.  But this is not the case.

People usually say that the short period of relief they got from hand surgery is not worth what they went through.  They felt the risk of surgery, the pain, hours of rehab, cost, complications and side effects related to the surgery and subsequent complications related to Dupuytren contracture recurrence did not justify what they got out of it.

It is reasonable to first be conservative. Try a simple natural approach to help your body heal the DC tissue, and so naturally remove the Dupuytren tissue.  Better to work hard to avoid needing hand surgery if possible.  You can always have surgery later if it is still necessary.

Learn about   Dupuytren’s natural treatment 

How effective is alternative Dupuytren treatment if the finger is completely bent?

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Hello,  I was just wondering how effective the alternative Dupuytren treatment is on someone whose ring finger is completely bent down towards the palm and will not straighten out.  Is this treatment effective on a severe case as this?  Or is it more beneficial to someone just starting to notice the nodules on the palm of their hand before losing use of their hand with deformity of their finger?

Please advise.  I would appreciate any other information that you may have on this disease.  I am trying to research this for my significant other who is having more and more discomfort with his hand.

Thanks so much!

 

Greetings,

Your concern and questions about effectiveness of Dupuytren treatment are common.

DCI is not capable of conducting the kind of research necessary to answer your question in the way I would like to giving you specific numbers for a controlled double-blind study.  For this reason, allow me to give you the benefit of my experience since 2002 while dealing with people from around the world who have finger contractures.  My experience is that for every 10-12 emails and phone conversations I receive reporting partial or complete success with the DCI method of Dupuytren treatment, I receive one report of failure.  Ten to 12 successes compared to one failure is pretty good.  It is human nature to complain and be negative far more than it is to compliment and be positive.  Because of this I take this 10 to 12:1 ratio to indicate significantly positive DCI treatment results.  I wish we had the ability to conduct multimillion dollar research, like the government or a drug company, so I could give you the statistics you are looking for.  For the time being is the best information I can offer.    

Duration and severity of Dupuytren contracture do not seem to be significant predictive factors that I can determine based on past results; sometimes severe cases do better than mild cases; sometimes chronic (old) problems respond as good as or better than acute (recent) problems. The greatest predictor of success or failure of alternative care has consistently proven to be aggressiveness of Dupuytren treatment and the person’s ability to closely monitor and define changes in size, shape, density, surface features, and degree of movement of nodules and cords.

There are well over 500 pages of information about Alt Med treatment of Dupuytren’s contracture on the DCI website. If you spend a little time reading and evaluating the DCI site you will have all the information you will need. If you have a specific question about Dupuytren treatment you would like answered please send it to me and I will do my best to provide an answer.

You will note that there is no change in the Dupuytren treatment approach if the fingers  are completely bent down or not, and there is no change in the treatment if the ring finger is involved as compared to the little or middle fingers. 

In other words, the DCI approach starts out the same if the fingers are mildly or severely bent; if one, two or three fingers are involved; if one hand or both are involved; if slight nodule or severe cord formation is involved; even if the person has had prior Dupuytren’s contracture surgery or not – the DCI approach starts the same for everyone.  This is so because the Dupuytren treatment is not directed specifically to the hand, but to the person.  This means that the DCI concept of care is intended to not treat the disease, but to treat the person who has the disease so the immune response is supported and strengthened.  By enabling the immune response of the person who has the problem to do a better job, it is our theory that each person will heal to the best of his or her ability to remove the offending fibrous nodules and cords, or at least slow down the progression of this problem.

What should I change in my Dupuytren treatment plan?

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Hi Dr. Herazy,

I am about to place my third order with you. I wanted to let you know about my 5 weeks of treatment so far. I started with your medium Dupuytren’s contracture treatment plan. For 2 weeks I have been taking 5 Neprinol capsules with 2 fundamental sulfur 3 times per day. I find it difficult to find times in the day where I haven’t eaten or plan to eat within 2 hours. I try to take one dose when I wake up in the middle of the night to visit the bathroom. Additionally I am taking your vitamin E and PABA (2 caps ea) once per day. I also try to take Scar X twice per day. Lastly I use topical vitamin E, copper serum with DMSO. This topical Dupuytrens treatment has really softend the surface of my palm. Callouses nearly gone.

I must say, it may be early in treatment but I have not noticed any difference in the dupuytren cords or nodules as far as reduction in size or hardness. I must tell you the unexpected good news about my foot. Plantar Fibroma (aka soft lumps) on the sole of my right foot. they are notably smaller. I have had them for 10 years at least. This to me is proof that your treatment is doing something. These foot lumps are not as hard as the hand dupuytrens lumps.

Additionally I have had 2 dupuytrens surgeries. First one in 2009 needle aponeurotomy. It was quick, some sharp pain during surgery. Results lasted about 3.5 years and grew back. My second surgery was just in Sept 2012. I tried Xiaflex. Dr. injected into the main cord only. It softened the cord enough where he could release it. I could hear and feel it snap like a rubber band. This is when I started your treatment. I am hoping your methods will at least prevent the cord from growing back. I still have cords running up my ring finger and in the web between my ring and pinky.

My questions to you are: what should I change? More Neprinol? or something else? I know you say its trial and error. I was just wondering if you had any comments or recommendations. I am sure these hard firm bands will take more time. But question the treatment plans effectiveness.

Also. When I wake I take my morning Neprinol dose with coffee. I know you say water but I can’t find three times per day where I can commit to 3 doses for 2 hour periods without some kind non-water intake. does caffeine negate the enzymes?

What about wine in the evening? Is that a no-no too?

Thanks for you help.

Jim VH

 

Greetings Jim,

Congratulations on the early progress you are making with the several problems you are dealing with. Five weeks is not a lot of treatment time and your therapy levels apparently have made some good tissue changes for you to be able to notice them so soon.  

What you have going on that puts you in a slightly different (and more difficult) category than a lot of people is that you have had multiple surgeries and you have more than just a Dupuytren’s contracture problem to correct. People who have had Dupuytrens hand surgery tend to take longer to recover while using Alternative Medicine, bu then again people who have had Dupuytrens surgery need this work a lot more since they have seen that recurrence of the lumps on the palm and cords is a real problem.  You cannot continue to have hand surgery when the problem will always come back, because a surgery or two more you will run out of tissue for the surgeon to work with.  At that point you will be worse off than before the surgery.  

I have worked with many people in the past who had plantar fibromas just as you do and I find that this tissue drains a lot of the Dupuytren treatment products away since it competes for them at the same time you are attempting to reduce the nodules and cords on your hand.  The more of these soft tissue problems that are present, the more therapy products that the body will need to address them all.  There is no way, other than the topical or external therapies that you use, to direct or select where the internal therapies will be used by the tissue; the rule apparently is an equal distribution since they travel in bloodstream.  I am confident that if you only had Dupuytren’s contracture and not the plantar fibromas to deal with, your current plan would be giving you greater improvement with the hand contracture problem. 

I suggest that you reduce the vitamin E to two capsules daily, total.  Also, I suggest that you consider taking perhaps three Neprinol more than your current dosage, and that you add these additional three to the end of the day when they will stay in your stomach and bloodstream longest while you go the longest time without eating.  You might also consider adding in acetyl-L-carnitine to your plan, starting at 3-4 capsules daily. 

Taking your Neprinol with coffee is not a great problem since caffeine does not influence the enzymatic activity or availability in any way.  Limited wine intake is also OK.    TRH   

How long will the best or large Dupuytren treatment program last?

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If I order the best Dupuytren treatment program, how long will that product last?

 

Greetings,

If you look at the information that describes the large Dupuytren treatment plan you will see the following: 

“While the large DCI treatment plan is the most expensive to purchase, it is not much more costly to keep resupplied so that your treatment can continue each month.  The monthly cost for resupplying the Dupuytren Large Plan is about $95-$120 per month.  Keep in mind that the Genesen pens never have to be purchased again, and that the Dusa-Sal DMSO and Unique-E topical oil are used very sparingly so that they are replaced about every 2-3 months under average use.  Your actual cost will depend on how aggressively and faithfully you treat yourself for Dupuytren.”

The large treatment plan for Dupuytren’s contracture is made up of 11 different therapy items.  Some never have to be replaced (Genesen Acutouch instruments), some need to be replaced every 2-3 months (DMSO and vitamin E oil) and others need to be replaced every 3-6 weeks (Nattokinase, Fibrozym, Fundamental Sulfur, PABA, Quercetin-Bromelain)  depending on how aggressively they are used.   The various therapy items are not used up at the same time, so there is no specific answer for this question.   This is the reason we offer an fairly accurate estimate that the average person will spend approximately $95-120 keeping the plan resupplied as things are used up at different times.  Compare this to the $90-110  cost to keep the better or medium plan resupplied each month.  TRH