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