Hello Dr. Herazy,
I have spent a few hours studying your interesting website. Thank you for making such a helpful website available that presents a different side of the story about what a person should do for Dupuytren’s disease.
I have many questions right now, but I suppose my biggest is “how does a person know it is time to actually have Dupuytren surgery?”
Lela from Delaware
Greetings Lela from Delaware,
From a medical standpoint there are a few very standard and simple tests that are generally used to determine who is and who is not a good surgical candidate – although this decision should not be made solely on the basis of a few numbers and angles, and a simple tabletop test.
Generally, Dupuytren surgery should be reserved for those who have hand contractures that keep the involved finger(s) at 30° flexion, or when the individuals has a positive tabletop test in which both the palm and fingers cannot be held flat against a tabletop. This makes the decision sound easy, but there are many more things besides age, past surgical history and the state of general health to consider.
In my opinion, when considering to undergo a Dupuytren release it is good to remember that no hand surgery for Dupuytren offers a permanent correction; all are a temporary solution because recurrence of Dupuytren contracture will happen sooner or later, usually within five years or so.
A Dupuytren release involves making one or a series of incisions into the palm to remove the dense, thick, contracted and inflamed soft tissue (fascia) that surrounds, supports, and separates the tendons and tendon sheaths of the fingers and hand, while preserving the arteries, veins and nerves, correcting joint deformities, preserving uninvolved skin, and maintaining proper flexion and grip strength.
A Dupuytren release does not cure or eliminate the disease. When it works out well it only temporarily modifies the progression of the disease and temporarily improves hand function. When it does not work out well it can result in a worse problem than before the release surgery. Recurrence is still likely after Dupuytren surgery.
The time to have Dupuytren surgery is when you have attempted to do every thing you possibly can to avoid it, and you have been unsuccessful. Additionally, there should be a strong feeling that you are willing to accept the risks involved and tolerance for the idea you might have to have additional hand surgeries in the future.
Before you submit to hand surgery I suggest that you attempt at least a few weeks of an intense program of natural therapies that we describe in Dupuytren Contracture Institute website. For a good place to start reading and learning, go to Start Dupuytren Contracture Treatment