Tag Archives: palmar fasciectomy

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

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

Posted on by STL314

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?     Worsening of Dupuytren’s contracture is not uncommon after DC hand surgery, regardless if your Dupuytren’s surgery was initially 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 multi-billion 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 

My Dupuytren’s surgery lately is going badly; do you have any suggestions for me?

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Hello Doctor,

I had Dupuytren’s surgery on my right hand on August 3, 2012. Most of the surgery involved the area below my little finger with the incision extending upwards to the adjoining ring finger. A nodule on my palm was also removed from the base of my thumb. I began therapy on August 31, after complaining about the pain. After 3-4 sessions, the therapist felt I was progressing well enough that it wasn’t necessary for them to check my progress.

My concern is that lately I am experiencing some numbness in my fingertips, wrist pain, and a shooting pain up my right arm. Also, I am unable to make a fist when I wake up. It generally takes 2-3 hours before I can make a normal fist without too much pain. I continue to do the prescribed exercises and wear an Isotoner glove each night.

It appears to me that my healing process is going in the opposite direction it should be going after surgery, as the pain and lack of range of movement and poor flexibility were not that apparent 3 weeks after surgery. I’m regretting the surgery already, as I can no longer workout with weights or anything that requires squeezing.  Do you have any suggestions for me?

Thank you for any help or ideas you can provide.

 

Greetings,

While you did not name the type of Dupuytren hand surgery you had, based on your very brief description and commentary I will assume (but feel rather confident) that you had some type of palmar fasciectomy, with several different types possible depending on the amount of tissue removed during hand surgery. 

To understand this hand surgery it would be good to first explain the term, palmar fasciectomy. The word palmar refers to the palm of the hand, that broad area of the hand that is in contact with anything being held and to which the fingers are connected.   The word fasciectomy refers to surgery that is performed to remove fascia from the body.  Fascia is a thin but tough layer of soft fibrous tissue that covers, surrounds and lines all tissues, organs, structures and cavities of the body.  Fascia is as thin as, and in a way is used in the body like, the plastic Saran wrap that is used to cover and protect food.  You can see fascia as the pearly white thin tissue membrane found in cheaper grades of roasts and steaks.  There is normally a considerable amount of fascia tissue in the palm of the hand to provide extra strength, durability, support and protection during the heavy work done by the hands. 

The “-ectomy” ending of the word fasciectomy indicates the surgery is done through an opening in the skin, and that something is removed during the surgery – fascia in the case of a fasciectomy. 

The exact course and degree of tissue removal performed during a palmar fasciectomy is based on the patient’s age, occupation, family history of the Dupuytren’s contracture, duration, location and severity of finger  contracture or degree of reduced range of motion, level of disability, general health, as well as history of previous hand injury and prior hand surgery. 

With that explanation out of the way, let us discuss your situation. 

It is probably important to DCI readers that your email was received on October 15, 2012, approximately two and a half months after your hand operation.  This means that for approximately the first three weeks or month after your Dupuytren’s surgery your progress was good, but you are saying during the next six weeks you are having new hand and arm symptoms and that you now feel you are regressing.

You did not mention if this was your first Dupuytren’s surgery; this is important in regard to how you decide to manage your hand problem.  Since you did not mention prior hand surgery I will assume there was none. 

Your description of a very brief period of improvement – in your case about a month –   followed by gradual appearance of numbness in the fingertips, wrist or hand pain, shooting pain in your  arm, stiffness and weakness in the involved arm is not uncommon for someone undergoing the rapid recurrence of Dupuytren’s contracture. There are many adverse things that can and do sometimes happen after even small or simple hand surgery that are totally unintended and unexpected.  Please see Dupuytren’s surgery risks for palmar fasciectomy for further discussion. 

I have no way of knowing if that is what is happening with you, but your flare up of symptoms fits in with the way that DC will always recur after surgery. On the other hand you could be going through some temporary complaints that are easily explained and common and consistent for the kind of Dupuytren’s surgery you had.  At this point I think you need to get some answers from someone who has direct knowledge and experience with the kind of surgery you had.

I suggest you go back to your surgeon and tell him exactly what you explained in your email to me.  If you receive a response that does not make sense to you, or you get brushed off with a hasty and unsatisfying reply, I suggest that you go for another opinion from a surgeon that is not associated with the surgeon who did your operation.     

Your story is a lot like many people who send me emails or call to discuss their results and side effects after Dupuytren hand surgery; I hear of bad results frequently and some much worse than what you are reporting.  From my perspective in doing this work since 2002 I observe that poor surgical results and aggravation or worsening of the original hand problem happen much more often than patients are being told prior to surgery; it seems that surgeons downplay the poor results and permanent pain, increased scarring, numbness and weakening that can happen.  They also seem to downplay the speed of Dupuytren recurrence; for some people it is never mentioned although it always recurs.   This is an unfortunate situation I hear about frequently.     

Lastly, I suggest that you consider doing your best to avoid additional hand surgery if at all possible.  The DCI site is all about the successful use of Alternative Medicine to support an encourage the natural healing of the Dupuytren’s nodules and cords.  Please spend some time looking over this information to see if it makes sense to you.  Let me know if I can assist you in any way.   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 is the difference between needle aponeurotomy and palmar fasciectomy and what are the risks?

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Needle aponeurotomy and palmar fasciectomy greatly different

Needle aponeurotomy and palmar fasciectomy are two completely different kinds of Dupuytren contracture surgery.  As with any kind of hand surgery done to release the contractures of Dupuytren disease, each has its own value, risks and limitations.  The risk and limitation of Dupuytren surgery should be considered not only because of the potential permanent consequences (numbness, reduced finger movement, reduced hand strength, reduced sensations and pain) that can occur, but also because hand surgery is not your only Dupuytren therapy option.

Alternative Medicine is a conservative and essentially risk free alternative that could make surgery unnecessary.

Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation in the palm.  Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider the conservative non-surgical and non-drug treatment options before attempting irreversible surgery.  To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

What is a needle aponeurotomy?

Needle aponeurotomy, also called palmar fasciotomy, is considered minimally invasive Dupuytren hand surgery since a scalpel is not used to open the skin of the palm.

Needle aponeurotomy is performed by inserting a hypodermic needle into the palm of the hand with the intention to move the needle tip in a variety of directions to cut, tear and weaken the offending cords and contractures in the palm.  Without being able to see the collagen structures he is slashing with the needle tip, the surgeon blindly attempts to destabilize and release those same cords and fascial contractures that prevent full straightening of the involved fingers.

Because these structures cannot be seen as the needle moves, the risk is that nearby nerves, blood vessels and tendons might be accidentally injured or destroyed

What is a palmar fasciectomy?

There are several types or palmar fasciectomy, depending on how much tissue is removed during this type of hand surgery.  Let us begin with the words, palmar fasciectomy.

Palmar refers to the palm of the hand. Fasciectomy refers to a kind of surgery performed on fascia.  Fascia is the thin, white, tough layer of soft tissue that covers, surrounds and lines all organs, structures, tissues and cavities of the body. You can think of fascia like the clear plastic Saran wrap used to cover and protect food.  When you look in the meat case at the butcher shop you can see all kinds of fascia in the cheaper grades of roasts and steaks.   Because hands need extra support and protection from the heavy work they do, there is normally much fascia in the palm.

The ending “-ectomy” means that the surgery is done through an opening in the skin and something is removed – in this case fascia.   So, a palmar fasciectomy is a surgery on the palm during which fascia is removed.

As an interesting aside the reader will note, above, that needle aponeurotomy was noted to also be called a palmar fasciotomy.  The ending, “-otomy” means that the surgery is done to cut into the body but nothing is removed, not even the fascia. A common “-otomy” surgery is a tracheotomy in which a hole is placed in the trachea, so that breathing can take place through the opening, and noting is removed.  So, a palmar fasciotomy is a surgery on the palm during which no fascia is removed.

Not all palmar fasciectomy is performed the same. The type and extent of a palmar fasciectomy is determined by the patient’s history of previous hand injury and surgical treatment, occupation, age, family genetics and family history of the Dupuytren’s contracture, severity and location of contracture, degree of disability, and general health status.

Different types of this Dupuytren surgery include a complete palmar fasciectomy (rarely done because of typically bad results after such large tissue removal), partial or selective palmar fasciectomy, fasciectomy with skin grafting, and amputation.