Tag Archives: dupuytrens recurrence

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

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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

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

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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  

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.

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

How do I prevent my Dupuytrens from coming back?

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I would like to thank you so much for the Non-Drug Non-Surgical Care for Hand Contracture. I had it real bad on my left hand, and the lumps have gone down 75%. I also have them on my right hand but they have not done as well.

My question is, how do you prevent them from coming back? I am also concerned that the right hand is not doing as well. I have total control of my hands. The disease has not affected my movement.

Again, words cannot express how grateful I am to have found your website and the advice on it.

Cheryl Diamond

 

Greetings Cheryl,

Thank you for the positive report.  I get several emails and reports like yours every week.  It really makes me feel great to know that the work of DCI is making such a big difference in people’s lives.  What you did not say in your question is that you have actually been on the DCI treatment plan for a very short time and have only ordered once from DCI.  This is a great amount of recovery considering how little time has past. 

Be patient with your right hand; it should come around in time.   Most of the time I see that the two hands do not recover at the same rate.   Even if it took you a few months to get the full use of your hands back, you are still doing a great job of recovery. 

I have worked with people who have Dupuytrens through DCI for almost 10 years now.  In that time no one has come back to me and reported that their Dupuytren problem returned.  Notice, I am not saying that the problem never recurs after the DCI treatment is used.  I am saying that no one has told me that it has happened – even though feel rather certain that if it did I would be the first to hear about it. 

Once you are as fully recovered as possible, i suggest going on a reduced plan for about 9-12 months to give your tissue full opportunity to heal and support to prevent recurrence.  TRH