Tag Archives: recurrence

Is there a way to get rid of Dupuytren’s contracture for good?

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Hi Dr. Herazy,

I noticed a small bump on my right palm which I expect to be Dupuytren’s Contracture. I am getting it checked out by a Orthopedic Surgeon tomorrow but would like to get your insight so I can assess treatment options if my lump does indeed turn out to be Dupuytren’s.

I understand from reading your website that the solutions recommended by the Surgeon’s often have a high recurrence rate for those inflicted. What I haven’t got a sense of from reading this website is the recurrence rate of those who have followed the Alternative Medicine plan outlined by your Institute. I’d like to get an idea of whether the treatment offered by your institute can (for some, if followed correctly) eliminate Dupuytren’s Contracture or if your plan simply reduces the impact of the contracture and allows people to resume activities while managing the contracture.

Long story short, is there a way to get rid of this thing for good? I appreciate your time and insight.

Best,

Karl

 

Greetings Karl,

Great question about Dupuytrens treatment results with Alternative Medicine, thanks for asking about this important topic.

As I have written and said many times as I communicate with people who have Dupuytren’s contracture, I am unable to conduct the level of research that is commonly associated with large universities, drug manufacturers or hospitals; DCI does not have any way of regulating or monitoring the Alternative Medicine treatment of any individual, nor do we have any way of evaluating outcomes from that treatment other than what I am told by those who use this method of treatment.  In fact, no one is obligated to communicate at all with me in regard to any aspect of their care.  As a result I only know what I am told voluntarily by people before, during and after their Dupuytrens treatment, and this is sometimes sketchy.  For this reason I do not have outcome data that you might expect to use to judge treatment results, as would be available from a billion dollar institution doing a multimillion dollar research project.  It is unfortunate that the anecdotal information coming in cannot be independently confirmed for better evaluation.  It would be great to be able to generate decisive statistics and numbers that we both are looking for, but that is the best I am able to do at this time. 

Having explained all of that, based on the current limitations I work under, there are four  important aspects of Dupuytren treatment outcome after using a DCI-based Alternative Medicine treatment plan I can definitely share with you that you can evaluate as you deem appropriate:

1.   I receive 10-12 emails and phone calls of a positive nature (people reporting various levels of improvement from total reduction of Dupuytren palm nodules and cords, or full and normal finger mobility, to only slight to moderate changes of those same aspects of previous hand problems), for every one email or phone call of a negative nature (people reporting no  improvement of Dupuytren palm nodules and cords, or continued loss of the same degree of finger mobility). Considering how people tend to complain more than they compliment, I take the 10/12:1 ratio of positive to negative reports after DCI treatment to be a strongly positive outcome. 

2.  As I talk or email to those people who report a negative outcome after using a DCI type Alternative Medicine treatment plan for their Dupuytren problem, I consistently find that they have not used a very large plan or they used their plan incorrectly in one or more fundamental ways that would tend to me make me consider that they did not use their plan correctly or at least not as described on the DCI website or as suggested in the information DCI and Online Natural Medicine provides to these folks.  Many times I learn this is done out of financial limitation, other times it is simply due to misunderstanding or obstinance against “being told what to do” although we never prescribe treatment but only make suggestions and offer ideas, or they are simply people who are only looking for a “quick fix” and are not inclined to do the work needed for thorough and effective treatment.

3.  While doing this work since 2002 with people who have Dupuytren’s contracture I have not had one person, not one, come back to me a year or two or ten later to report their hand lumps or cords or finger contracture have returned.  I am unaware of any recurrence from people who have improved after using the DCI concept of Alternative Medicine treatment to help their recovery from Dupuytren’s contracture.  Recurrence might happen after DCI treatment, but I have not been told by any of these folks that their hand problem returned. It is my assumption that if recurrence does happen, I would be told about it by some percentage of these people many times during this many years; this would be especially true if you consider, as I mentioned previously, that people do tend to complain more than they compliment. I also do not ever notice that someone who was ordering products from DCI several years ago will suddenly begin to order therapy products again after a several year absence.  This would further tend to support the idea that people do not experience recurrence of their DC problem after this method of treatment.

4.   Many of the people who come to the internet for help with their Dupuytrens begin their search only after the recurrence starts after their first hand surgery.  Many are alarmed to find their hand problem recurred just six months or a year after surgery, and they are looking for alternatives rather than risk losing more hand tissue to the surgeon.   I speculate that approximately half of the people who are following a DCI treatment plan have already had one hand surgery, and occasionally even two or three surgeries.  For any of these people to experience improvement, and be able to avoid additional surgery, is truly wonderful and a testament to how the body is able to recover from a serious problem when given a little assistance with Alternative Medicine.   Natural recovery after having hand surgery is usually not as satisfactory as those who have never had hand surgery.  This reduced outcome makes sense since after hand surgery they have less normal and healthy tissue available.

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.

Dupuytren hand surgery can be dangerous: Facts you should know

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Risks of hand surgery as a limited Dupuytren treatment

Any type of surgery presents risks and can produce unintended side effects.  Unanticipated complications following open hand surgery for Dupuytren contracture has been reported in 17% to 41% of cases.  Further, these side effects are nearly twice as likely to occur for repeat surgery when Dupuytren’s contracture recurs after a first surgery.

This article will focus on the potential complications of Dupuytren’s contracture surgery, specifically a category called palmar fasciectomy.

Avoid Dupuytren hand surgery with Alternative Medicine

Anyone considering Dupuytren surgery should be encouraged to know that by natural Dupuytren treatment it might be possible to avoid a hand operation.

Medical research by Messina, Loos, and Bulstrod report successful outcomes for Dupuytren contracture after using the non-surgical methods of massage, exercise and traction, yet their work receives little attention.  Research interest has always been primarily directed toward high profile profitable surgery and drug therapies. Alternative medicine is not a high profit way to treat hand contracture although the Dupuytren Contracture Institute has been helping people since 2002 deal with their hand problems.

Not all people respond to Alternative Medicine, just as not all people respond well to drugs and surgery.  However, the advantage with using simple and low cost natural therapies and remedies is that when they do successfully assist the body to recover from a health problem, the need for drugs or surgery is lowered or eliminated.  The idea of attempting a short therapeutic trial of natural remedies first, rather than last, takes advantage of conservative ideas at the beginning of care.  Later, if Alternative Medicine fails to assist the healing response then more aggressive drugs or surgery can still be used.

The Dupuytren Contracture Institute is not against hand surgery for Dupuytrens contracture.  Obviously there is a need for surgery when natural methods have been unsuccessful.

The risk and limitation of Dupuytren surgery should be considered not only because of the potential permanent consequences (permanent pain and numbness, reduced finger movement, reduced hand strength) that can occur, but also because surgery is not the only option to reduce palm lumps and finger cords.

Hand surgery is not final

Two primary cautions should be kept in mind before submitting to surgery for the hands: First, even when Dupuytren’s surgery is done well by a skilled surgeon, unintended consequences occur that no one can anticipate or explain.  Second, Dupuytren surgery is well known to   stimulate the recurrence of additional nodule and cord formation in the palm after removal – sometimes as soon as in a single year, often three or four years.  Since Dupuytren contracture is famous for recurrence within a few years after surgery, anyone thinking about a surgical option should realize that once the first surgery is done it is just a matter of time before the next surgery will have to be done.  The typical pattern is that with each Dupuytren surgery the next recurrence of hand nodules will be a little faster than the last.

The only way to know for sure if Alternative Medicine will stimulate the natural healing process is to use a solid round of natural remedies for a month or two to determine if positive changes occur.  If successful, then the patient should consult with her physician to learn if surgery can be avoided.  If it does not help, then surgery can proceed knowing any potential risk is justified by the lack of progress with conservative methods. .

To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

 

 

 

Do Xiaflex injections really have a low Dupuytren recurrence rate?

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What does “recurrence rate for Dupuytren contracture” mean? 

Dupuytren contracture is famous for the fact that in about half of the cases the problem returns about five years after hand surgery. For some people the reappearance is as soon as one year after an invasive operation to remove the cords, nodules and contracted hand tissue.  Many people are disheartened to learn that surgery and Xiaflex injections are not a final answer to their hand problem because of Dupuytren recurrence.

Consider a brief delay of Xiaflex injections to see if natural remedies might help

The Dupuytren Contracture Institute is not against Xiaflex injections or surgery for Dupuytren’s contracture.  Since 2002 our position has always been to recommend surgical intervention in those cases that have not responded to an aggressively applied round of conservative Alternative Medicine therapy.  If a brief therapeutic trial of natural Alternative Medicine treatment has limited results, we then advise to have an evaluation from two doctors who specialize in Dupuytren’s contracture for possible surgical or Xiaflex intervention.

>> Natural Dupuytren Contracture Treatment – FAQs

>> Testimonials from Dupuytren Contracture Institute

However, there are those who approach the management of their Dupuytren contracture in the reverse order:  They first have hand surgery for their Dupuytren’s problem and only after the problem recurs do they consider conservative treatment.

People from around the world report they rushed into having a hand operation, not knowing of the possible side effects and recurrence issues that develop after invading the area of Dupuytren’s disease. It is DCI‘s opinion that it is safe and reasonable to attempt to improve the body’s ability to heal and repair the problem of Dupuytrens contracture by aggressively using several conservative Alternative Medicine treatment measures for a short time.  We strongly suggest that anyone with Dupuytren contracture works with what is known and what is available – even if it is not perfect – before submitting to potentially risky surgery.  If DCI’s conservative concepts do not improve or eliminate the hand lump, Dupuytren’s surgery can always be done later.

How low is the Dupuytren recurrence rate after Xiaflex treatment?

Auxilium Pharmaceutical, manufacturer of Xiaflex collagenase injections, boasts that in a two-year study Xiaflex had a recurrence rate of 19.3 percent, a considerably lower rate of return than those who used surgical procedures to treat their hand problem.

The answer to the question “Is the Xiaflex recurrence rate for Dupuytren low?” is a qualified yes and no.

Yes, Xiaflex or collagenase treatment results in a considerably lower Dupuytren recurrence rate than hand surgery.  However, this does not necessarily mean that the rate of recurrence is actually low; it only means the problem will come back slower than what happens after invasive hand surgery. The reality is that hand surgery has a tremendously high recurrence rate, so a non-surgical therapy option by comparison will look favorable.

Every child learns that pointing to someone who has done something worse than you does not diminish his crime.  When you told your mother that the child next door stole 25 cents from his mother, you were trying to make yourself look pretty good for stealing only 10 cents from her purse.  Your mother was not swayed by the faulty logic of a scared child.  In the final analysis, even though the numbers were different, both children did something wrong.

And along a similar line of thought, 19.3% recurrence is still a high rate for Dupuytren contracture to come back after being subjected to an invasive medical procedure that carries risks, even though there are other treatment methods that have a considerably higher rate of recurrence.

Most surgeons will admit that any type of physical invasion into the palm (like with surgery or injections) seems to accelerate the progression of Dupuytren’s disease.  Patients note that their previously slow progressing hand contracture not only recurred after surgery but worsened at a faster rate.

Perhaps a better question to ask is, “Would you want to undergo an invasive medical procedure like a Xiaflex injection series, knowing that 20 out of 100 people will have to do it again in two years?”  The answer should take into account that more injections might not be as simple and uneventful as receiving the first Xiaflex injection.

Xiaflex has a short history of treatment of Dupuytren contracture

Since Xiaflex was given FDA approval for Dupuytren contracture treatment in early 2010, not enough time has lapsed and not enough patients have used this procedure for the FDA to know sure what will happen to those 19.3% of patients who have recurrence within two years after receiving a second – or third or fourth – injection series.

For example, recent research information released about Xiaflex at the three year follow-up shows that 34.8% of joints with initial clinical success experienced recurrence, considerably higher than the 19.3% recurrence rate reported at the two year mark.  It is reasonable to speculate that the Xiaflex recurrence rate will continue to increase at the four and five year follow up marks, bringing Xiaflex recurrence much closer to the frequency of hand surgery.

There are two valid issues to consider about repeated injections with a new drug like Xiaflex:

  1. When Xiaflex is injected to dissolve the collage cord of Dupuytren’s contracture it carries the risk of physician error and unintended drug consequences, such as injection into a nerve or artery, accidental leakage causing destruction of tendons or muscles, or drug side effects.
  2. No one knows the long term consequences of multiple Xiaflex injections over time into the same area. After all, 70% of people who receive their first Xiaflex injections find that the Dupuytren cord does not break as it should; they must return one month later for another series of injections; if this does not work, they again must return in one month later.  The manufacturer does not recommend that anyone receives more than three series of Xiaflex injections if it did not dissolve the cord by that time.  In this way the manufacturer of Xiaflex is admitting there is a reasonable limit to how often and how much this drug can be used for the same cord.

Return of Dupuytren after hand surgery

There are two common types of Dupuytren hand surgery. The first is palmar fasciectomy (cutting the palm open to remove the deep connective tissue of the palm and collagen cords) with a 35% recurrence rate after two years.  The other is needle aponeurotomy or palmar fasciotomy (inserting a needle into the palm and blindly slashing at the Dupuytren cords wit h the tip of that needle) with an 85% recurrence rate after two years.

By comparison, yes, the Xiaflex return rate of 19.3% recurrence at two years is lower than aggressive surgery. However, this recurrence rate for Xiaflex is said to be low only because the recurrence rates for the other types of surgery are so terribly high by comparison.

At the Dupuytren Contracture Institute we take the position that it is better to avoid the risk the hand problem will return after undergoing any kind of hand surgery by first attempting Alternative Medicine natural Dupuytren treatment.

Should I have a third Needle Aponeurotomy surgery for my Dupuytrens?

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Dr. Herazy,

I have dupuytren contracture in my little finger on my left hand and have had needle aponeurotomy done on it twice.   It is aggressive and I was considering the procedure a third time  and just heard about you.  I’d like to try an aggressive treatment with you instead–have I missed an opportunity to improve my situation because of the needle aponeurotomy sessions (because of  scar tissue,etc)?

I’d like to speak to you about it if possible – I have a third needle aponeurotomy session scheduled two months from now (28 Nov) that I’d like to cancel…the contracture comes back quickly and the finger is a bit thicker.  Any advice??

Thank you in advance for your attention to this,

Scott Riviere

 

Greetings Scott,

Needle aponeurotomy is well known for rapid recurrence of Dupuytren contracture.   Although you did not say how quickly your Dupuytren’s returned after your first and second hand surgery, it is not uncommon for the palm lumps and cords to come back back in two years or so, with the rate of recurrence increasing after each NA surgery. 

The increased thickness of your finger could be due to chronic swelling or edema that is the result of scar tissue that prevents normal drainage of blood and lymph fluid out of the hand.   Or, it could be directly due to scar formation from the internal cutting that is part of the NA technique.  Either way, this is a frequent side effect of hand surgery for Dupuytrens.   

The rapid recurrence of Dupuytren contracture after needle aponeurotomy and scar tissue build-up are two of the nasty consequences of this kind of hand surgery simply because, as you have found out, the technique not only solves nothing but it can leave you worse off than before it was done.      

My advice is that you be extremely cautious about undergoing a third needle aponeurotomy.   What has your surgeon told you about the possible outcomes of a third NA if the first and second did not help you and resulted in undesirable side-effects?    Did he/she say why you should expect the results of this third surgery to be any different than the first two?   Did he/she warn you about further acceleration of the rate of recurrence with each succeeding NA procedure?   Did he/she warn you about the increasing risk of possible injury to blood vessels, nerves and tendons that occurs with each succeeding hand surgery?    Did he/she warn you that these hand surgeries would eventually have to stop?   Did he/she speculate what the eventual condition of your hand might be if you had 4-5-6 surgeries, and how useful, painful, numb or flexible your hand might be?   did he/she discuss with you what your options might be when you can no longer have additional NA surgeries?

Please be even more cautious if you are told that this next surgery will be more extensive to reverse or clean up the problem scar tissue that resulted from the others.  I have never heard of any  “clean-up surgery’ that goes well for the patient; usually it goes in the opposite direction and creates more problems.   Mind you, I am not saying to not have the surgery and I am not saying to not listen to your doctor, I am just saying to use the highest level of caution and prudence when you make this decision.

Time will tell how effective an aggressive Alternative Medicine treatment plan might be to help your current condition.  I have worked many times with people who have a history of past hand surgery who find their problem worse than when they started; some make great improvement, while most make at least a small to moderate amount of change; very few do not at least make some small level of improvement.   I cannot answer you directly about how effective natural therapy might be for you, but considering your options I suggest you consider undergoing an intense round of therapy for 2-3 months to determine how much change your body can make.   You will only know for sure when you give it your best effort.   

I would be pleased to speak to you about your Alternative Medicine treatment options.   The important thing is to not make matters worse at this point.   Simply call me at 847-670-8800.     TRH