Dupuytren surgery recurrence is always an important factor when deciding treatment options

Dear Dr. Herazy,

My mother has had problems with her hands for a few years. We couldn’t find a cause of the problem. Recently one of the doctors diagnosed the disease name. He told her that it’s Dupuytren’s contracture. However, in South Korea, only available treatment is a surgery. It’s very rare disease over there. No doctors have much experience to perform that particular surgery. He recommended her to get treatment in the U.S in which many doctors are experienced to perform and other treatments are also available. Other than surgery, there are other options such as injections and needle treatment as the doctor recommended.

Therefore, she is flying to the U.S in early November to get her treatment. Length of her stay will be about one month. She doesn’t have medical insurance there so that she will be a cash patient. Please, recommend me which treatment is best for her with estimated cost. Currently ring finger on one hand is severe. However, ring finger on the other hand is getting serious as well. As she can’t stay in the U.S long enough, I would like to know what treatment is best for her situation.

When decisions are made, I would like to make an appointment for her so that she can get to her treatment as soon as she gets into U.S.  Please, reply me as soon as possible. You can reply on my email or give me a call to xxx-xxxx-xxxx. I am looking forward to hearing from you.

Thank you.

Greetings,

Since your mother is having to make such difficult and expensive travel plans to come from South Korea to the U.S. specifically for Dupuytren’s treatment, it is very important that you keep in mind that all Dupuytrens surgery will tend to recur.  This means that typically within a few years after the first surgery, the Dupuytren’s contracture problem will return usually worse than the first time around.  Dupuytren surgery recurrence of hand contracture is a major problem with all the treatment options you mentioned. 

The hand surgeons tend to minimize this problem of the Dupuytrens cords and nodules returning, but it is real and worth considering as you make your decision.  Since this would require another trip back to the U.S. and more expense for your family I suggest you ask many questions and read the information available on this website about Dupuytrens recurrence so you can judge for yourself what is the best direction to take.

There is no way for anyone to say which is the best treatment direction in her situation without knowing more about her particular problem and examining her.  

I suggest that she consider not having the Xiaflex injections, needle aponeurotomy or open hand surgery since all of these carry the risk of complications that could be extremely difficult to handle within the limited time she has available to her for treatment.   I suggest that she consider following a course of Alternative Medicine natural treatment for Dupuytrens contracture for perhaps a few months to see if her hands respond favorably to conservative management.  The advantage to this approach is that it is done without the risk of complications or recurrence.   If the procedure does not help her she can always submit to surgery at a later time.    TRH  

Can needle aponeurotomy be done for Peyronie’s disease?

Needle aponeurotomy for the hand is all I see online. I am a Kaiser Permanente subscriber and even at that, I don’t see anywhere online where needle aponeurotomy is performed on a penis…Got any suggestions? Do you know of any Urologist in my medical plan who does needle aponeurotomy for Peyronie?

Sincerely,

Martin Carroll, Jr.

 

Greetings Martin,

Well, you are certainly an adventurous person.

Needle aponeurotomy is a type of surgery done on the palm of the hand to surgically reduce the cords that develop in  Dupuytren’s contracture.   It is surgery performed by inserting a needle under the skin of the palm, and then blindly slashing and tearing at the cords and contracted fascial tissue since the skin is never opened by the surgeon so he/she never actually sees the tissue that is being cut and torn.  The purpose of this procedure is an attempt to weaken and reduce the cords under the skin, so that during the operation the surgeon eventually is able to break or snap the weakened Dupuytren cords.  The recurrence rate for this procedure is fairly high, about a year or two faster than conventional hand surgery.

There are many hand surgeons who are proponents of this technique, and others who are not.  No surgical technique is perfect, and they  all carry risks.   

This same technique of using a large gauge needle to act as a cutting tool is already being done to reduce the Peyronie’s plaque while the actual slashing and tearing of the tissue is not observed during the penis surgery.   This technique of weakening the Peyronie’s plaque with a needle tip is called the Leriche technique for Peyronie’s disease.  When done for Peyronie’s disease it is not called an aponeurotomy since there is no aponeurosis in the shaft of the penis.  To coin a phrase it could be called something like a Needle Tunicotomy, since it is the tunica albuginea of the penis that would be surgically cut  by the needle tip and left in place, but I have never seen that term published anywhere since i just made it up.  To read more about this procedure click on Leriche technique for Peyronie’s surgery

I must wonder why you are interested in exposing yourself to the risks of any surgical procedure four your penis if there are less risky non-invasive Alternative Medicine options that you have not explored?   TRH

Is forceful stretching and finger straightening harmful to Dupuytren contacture?

Dear Dr Herazy,
Thanks for your website, I find it to be a helpful and positive source of interesting information.  I have a couple of questions if you have time.
I was diagnosed with Dupuytren hand contracture early this year. At that time both hands hand small lumps and had some pain.  In the last week I noticed the right hand is getting worse faster and the little finger and ring finger are not as easy to straighten.
I’m doing two things at the moment, deep rubbing and stretching the lumps on my palms and forcing my fingers straight, and applying Vit E ointment. Are there any problems doing this, and what more can i do to help myself?

Regards
Andrew

Greetings Andrew,

Yes, there could be a huge problem with what you are doing.  Please stop doing that aggressive rubbing and stretching of the palm lumps, and do not forcefully stretch or straighten your fingers.  This is not a good way to treat your Dupuytren problem.  Applying vitamin E by itself to the palm of hand over the nodules and Dupuytren cords is not very effective.  When vitamin E is applied without DMSO to drive it into the tissue the vitamin E oil will not get in deep enough to benefit you.  While it might not harm you, it is not doing you much good as you are applying the vitamin E incorrectly.

I know you might think it makes sense to forcefully reverse and straighten your bent fingers, but you could be easily hurting yourself.  By aggressively reversing the flexed finger position it is possible to over-stretch, irritate, tear and even rupture the tendon sheaths related to the fingers that are involved in your Dupuytren contracture.   You could injure yourself by trying to force the deep palmar soft tissue to do things it is not ready or capable of doing at this time. These things take time to be done correctly.

To work with the deep and superficial soft tissue of your hands requires a special technique that will get the job done and at the same time avoid injury.  It is now mid-2011 and I am about half way finished working on a book that will explain the safe and effective way of doing soft tissue work on your Dupuytren contracture without injuring yourself.   Please look for the book in early 2012, titled, “Dupuytren Contracture Handbook.”

Rubbing vitamin E oil by itself is not very effective, and used without DMSO to drive it into the tissue is not getting in deep enough to benefit you.  Please read the website page about DMSO to learn why you should not use vitamin E alone to treat your palm lumps.

Please spend some time reading whatever interests you on the Dupuytren Contracture Institute website.  Learn how to conduct a safe and effective Alternative Medicine treatment plan for Dupuytren contracture.

TRH

Dupuytrens Surgery Did Not Go Well

Dupuytrens contracture surgery did not go well

I have already had surgery for dupuytrens contracture in my left palm. The surgery was not well-performed and my little finger is again bending at 45 degrees. I suspect some of the dupuytrens cords were left in my finger and palm as it looks to me as if the cord is reforming in my palm. I am 57.

Would any of the supplements on the site be of any use at this stage?  If so, which would be the best to buy and what would the dosage be?

thanks
Lisa


Greetings Lisa,

Sorry to learn of your problem.

It would have helped a bit if you would have mentioned how long ago your Dupuytren surgery took place, however I think I can still offer a meaningful reply to you.

To answer you well, a few things come to mind:

1.  All Dupuytren contracture will eventually recur after surgery.   Sooner or later the hand nodules and cords will develop again.  lThe fact that your little finger is again flexing in toward your palm does not necessarily mean that your surgeon did a bad job; your surgeon could have in fact done a spectacular job, and your Dupuytren problem would return anyway, given enough time.  It is said that for about half of the patients who have Dupuytren contracture surgery the palm lumps and nodules and finger contractures will return in approximately five years or so — for some people it might be a year or two, and for others it might be ten years, but five years is an average time for recurrence after any Dupuytren surgery.

2.  You wrote: “The surgery was not well-performed and my little finger is again bending…”   Do you mean that there were other issues and problems that told you right after surgery that your surgery was not performed well, or are you assuming that because your contracture is recurring that the surgery was not performed well?

3.  The recurrence of the Dupuytrens is not due to “…some of the dupuytrens cords [being] left in my finger and palm…”   Dupuytrens is not like a cancer that must be completely removed, or it will spread.  If all of the cord material was removed, or if some was left behind, you would have had this recurrence after a few years.

4.  From my experience, most surgeons tend to underplay or intentionally “forget” to mention certain things about a proposed surgery that might discourage a patient to have that surgery.  What would have happened if your surgeon had said something like this to you before your surgery?:  “You know, Lisa, we are going to cut here and cut there on your hand and finger, it will hurt pretty bad for a week after the surgery, and you will have to do rehabilitation for a month or two that will also be rather painful.  As a result of this hand surgery there is a good chance you will lose a little bit of feeling in your fingertip and you will also find that you will not get back full use of your finger because it will be permanently just a little stiff, and you will be able to predict bad weather in the future.  And, oh, one last thing:   I will do the best job for you that I can, but no matter how good I do, your Dupuytren contracture will come back in about five years — give or take a few years.  Actually, once I start doing Dupuytren surgery on you, I will have to keep on doing them because the condition never really goes away.”  You might not have had that surgery.  And that would mean your surgeon would have been a little less busy that week.

5.  There is not any way I or anyone can tell you ahead of time which of the DCI therapies may, or may not, be successful for you.  These are not drugs we are dealing with.  We are attempting to use naturally occurring nutritional substances to stimulate and support your ability to heal and repair the Dupuytren contracture and related soft tissue reaction in your hand.   Further, there is no best one to use.  They are all important and effective in their own way and all contribute to your effort to recover from the Dupuytren contracture.  What makes the DCI approach different and more effective than other Alternative Medicine approaches is that we recommend that you combine several therapies at the same time to “gang up” on your hand problem and support your healing potential to the maximum of your ability.   To understand this better I suggest that you read Dupuytren Contracture Treatment Philosophy and Dupuytren Contracture Treatment and Alternative Medicine.

6.  Dosage is always an important question.  Dosage is started at the lower end of what is suggested on the label of each therapy product.  From there it is increased in a way and at a rate that is thoroughly explained in the literature that is sent to you with each order you receive. You will be given complete instructions and suggestions to increase your dosage and manage your treatment in a way that will lead you to the highest level of recovery that is within your potential to heal and repair.