Why not perform hand surgery before my Dupuytren contracture gets worse, while it is still small?

Hello: I have just recently been diagnosed with Dupuytren’s contracture. I noticed a small hard bump/lump appear in the palm of my right hand, as well as one on the bottom of my right foot. I have just turned 50 and I am female. If the outcome is ‘black and white’, why not perform hand surgery to remove the bump BEFORE it grows into a long band deforming the fingers / toes?  Why wait ?

 

Greetings,

The answer is simple:  Dupuytren contracture recurrence after surgery. For more discussion of this topic see Dupuytren Surgery and Recurrence of Hand Contracture.

You are a little younger than average to develop Dupuytren’s contracture (hand) and Ledderhose disease (foot), and for this reason you are more likely to have an ongoing problem with Dupuytrens; the earlier in life it starts, the more aggressive and difficult the palm lumps and cords tend to be.  Your doctor is trying to delay your surgery for Dupuytren’s contracture to delay the time when your first recurrence starts.

Let’s say you had hand surgery the way that you propose.   If you had your first Dupuytren’s operation at age 50, it is possible to have your first recurrence start within two years.  Following your idea of early surgery to prevent progression of the problem, let’s say you had your  second hand surgery as soon as the recurrence appeared, and the next Dupuytren’s recurrence again appeared within the next two years.   Following your idea of early surgery to prevent progression of the problem, let’s say you had your  third hand surgery as soon as that next recurrence appeared,  and the next recurrence again appeared within the next two years.   Again, you would theoretically have another surgery for Dupuytren’s recurrence, with another recurrence, and so on. 

The above example does not work for three reasons:

  1. Recurrence of Dupuytren’s contracture tends to accelerate with each surgery, so that if the first recurrence did take two years to eventually develop, the net recurrence would be a little faster or sooner; maybe 18 months.  And if you had another hand surgery after that recurrence, the next recurrence would theoretically be even faster or sooner; maybe 12 months.   Of course, all these numbers are just made up, and could be faster or slower depending on your individual characteristics, family history, life history, clinical information and luck.   Some people wait 10 years for their first recurrence of Dupuytren’s contracture, but some people wait just a year – or even less for their first recurrence to appear.  Once the surgery starts, the process of recurrence starts; it is inevitable.   
  2. Each Dupuytren’s surgery “uses up” or removes normal hand tissue.  You cannot have too many hand surgeries without soon having little normal tissue remaining.  Depending on your individual circumstances you might only be able to have one, two or three hand surgeries in your life before your surgeon would inform you that you cannot have any more.   What do you do at that point?  You allow it to get worse, and perhaps become so bad in terms of pain that amputation is your only option. 
  3. No good surgeon would perform an early Dupuytren surgery, such as you have proposed.  Hopefully you would never find a surgeon who would agree to cut early, because he/she would know that this would be a terrible decision that would lead to a terrible result.  

There are drugs that have risks that can be used, and there is surgery as an option for you to consider. I suggest that you should consider trying to avoid Dupuytren’s hand surgery completely.  Since your problem is early and small at this time you are in a good position to try to reverse this process naturally.  I suggest you do some reading to see if this makes sense to you.  You can always try it for 2-3 months of intense natural therapy while you are waiting for your Dupuytren’s to progress.  If it work, fine – look at what you have gained.  If it does not work, as sometimes happens, you can always have your hand surgery when your surgeon thinks you are ready for it.  

For further information about treating Dupuytren’s contracture naturally you can read What is the best therapy to treat Dupuytren contracture?    TRH

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

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

Can this natural Dupuytren treatment reverse the bad effects of needle aponeurotomy and Xiaflex injections?

I was diagnosed with Dupuytren’s in 1994. I had a palmar fasciectomy in 2005 on the left hand which failed and resulted in amputation of my little finger in 2008. In 2011 I had a more extensive palmar fasciectomy on the right hand which has also failed. The little and ring finger of my right hand are fully contracted and the ring finger on my left is about 30% contracted and all are getting worse. Do you have data on how your treatments can reverse this condition and that of surgery, needle treatments and Xiaflex?

Are your treatments accepted by insurance companies? Mine, Molina, even denied covering Xiaflex, which I am fighting.

Thank you.

PS: I am very familiar with DMSO having used it on horses for years and would be open to trying it.

 

Greetings,

Sorry to hear of your bad results with Dupuytren’s hand surgery and Xiaflex injections.  Unfortunately, your experience is more common than what you might imagine.  Please see Dupuytrens Surgery Did Not Go Well   and When to have Dupuytren surgery? Also, the worsening of your hand is not uncommon either after hand surgery, regardless if your Dupuytren’s surgery was successful or not.

As I have repeatedly written here on this DCI website, I am not able to produce data and research results like a multibillion drug company that controls patient drug intake and has the ability to monitor outcomes.   I can only report what people tell me after they have been on their program for a while.

For every 10-12 reports of success and positive results while following a reasonably aggressive DCI treatment plan I get one report of failure or lack of positive results.  This is a good ratio, especially when you consider how people like to complain as opposed to give compliments and offer thanks.

However, you ask about reversal of bad results of Dupuytren surgery.  That is something you should have asked your various surgeons before they removed so much normal tissue from your hands, and injected enzymes to dissolve tissues in your hand.  Unfortunately you are asking too much of your body to think that taking any kind of superior nutritional program could possibly make new tissue grow back after a surgeon removed it.  It simply cannot be done.  At this point I think you should be interested in simply making the best of a very bad situation.

Since you have had such poor results with what you have tried so far I suggest that you be most conservative from this point forward.  I have never had anyone tell me of any adverse or unexpected results from the work we do here.  Please consider trying this approach to see if you can at least slow down some of the contraction that is going on in your hands.  At this time I think you do not have much to lose.  TRH