Surgery for Dupuytren's contraction
Last April I posted asking if anyone has had experience with surgery for Dupuytren’s contractor. I have now had surgery Feb 4 for my left hand and ring finger. The finger was bent at 45 degrees from the rest of the fingers. In the past two years nodules between the first two joints had filled in with a large mass. The effect on my playing was minimal in that I still had the range of motion to play, but it was getting more difficult to get in fast notes with any intricate fingering such as triplets. The main problem was that I was told that if the second joint gets compromised, that permanent damage is done to the joint and the surgical out come will not be so good. It was becoming clear to me that I was arriving at the point where I faced a greater risk by not having surgery.
I interviewed four surgeons over about a six month period from a list my hand therapist had given me. Two recommended a needle aponeurotomy, and two a complete resection. The needle aponeurotomy would be a less invasive procedure, but the problem would be more likely to recur as one is only releasing the contractor. The other two surgeons felt that the bands were too thick for a needle aponeurotomy and there would be greater risk of causing nerve damage from not being able to see entirely the exposed anatomy. I decided to go with the complete resection.
I was knocked out for the surgery which took two hours. My hand was well bandaged in a partially hard cast, my ring finger now straight as I have not seen it in six or eight years. Eleven days later the stitches came out, but the incision was not completely healed although basically closed. I saw a hand therapist every other day for dressing changes and my hand was put in a splint to keep the ring finger straight with the little finger. We did some bending at the time of the dressing changes and I was told to start moving it twice a day. I could not make a fist. At day 19 the steri strips came off and I just wore a sock like for protection. I played a scale that night. On day 20 I played for two ½ sessions with a half hour rest between. From that time on I was able to increase my playing time and made it to the chamber orchestra rehearsal on day 26. My finger felt fine. On day 38 the incision is still sore to the touch in the palm of my hand, but less so on the finger. I have little feeling on the scar side between the two joints but this is because the skin is rather thick there. I definitely had feeling when the stitches came out. The tip of my finger is sensitive and feels tingly. I am told that it will take some time for it to feel normal again. I am to sleep with my hand in a splint for six months to keep the finger straight at night. I am told the reason is to keep scar tissue from bending the finger. The finger is still stiff some and I cannot make a tight fist yet. Physical therapy consist of therapy clay, bending against the clay. I don’t think there is any permanent nerve damage and I believe over time I’ll get most if not all of it back. A surprise is that my vibrato is a lot better now. I realize now that one does not notice changes that occur slowly over years. The director of the chamber orchestra also commented that I was moving better the first night I was back. I guess the contraction was making my hand less flexible. My teacher had also commented that there was a lot of tension in my hand during our discussions of the effect of the contraction.
I have no regrets and believe the surgery was the best option that could be done. Any surgery should be done by someone with experience and a track record for operating on Dupuytren’s , and a good hand therapist is an absolute necessity. I have since discovered that a retired organist in our church has had three surgeries for Dupuytren’s over the years on successive fingers (two on one hand, one on the other) and he can move his fingers fine. The scars are barely noticeable. I will post again in a few months on my experience.
Replies (9)
Wendel,
What great news from you. i too have Dupuytren's and am weighing the options. One hears so many horror stories about surgical treatment, I suppose because people tend to write more about failures than success. It's nice to hear of good outcomes.
Do you know about www.dupuytren-online? It's a great resource.
Good luck.
Yes. I looked at a lot of websites and have talked to a lot of people. I did not find a musician until after the surgery, the organist I mentioned, whom I ran into with my hand bundled up. I first consulted with a hand surgeon probably around 2003 who told me at the time there was nothing that he knew of that I could do to stop it (for example stretching the hand). It has started in my right hand about a year ago. It appears to be limited to the ring finger for me. I mentioned in my April that I had a pretty severe injury of my ring finger on my left hand in April of 2007. I stepped into a beach volley ball game, not thinking about my ring finger sticking out from the others, probably about only 20 degrees at that time. I would say that injury was a bigger problem then, and so I got my first experience working with a hand therapist. Which also brought up the concern about the possibly of a future injury, falling off my bike or something (I ride a lot).
I'm so glad to hear that the surgery has gone well for you. You seem to have regained a lot of ground quickly, considering how long your range of motion had been limited.
Do you feel that Dupuytren's is set off by injury? I seem to have developed it very suddenly following surgery for a trigger finger. No family history, none of the listed risk factors, right middle finger now at an almost 45-degree angle from the others. I'm not happy.
Everything I have read is that it is a genetic thing common in people of northern European descent. I have no relatives that I know of who have had the condition. Mine started sometime around 2000 or 2001, when it was first noticed by a physician friend of mine. My right hand started about a year ago. Whether there is solid evidence that an injury would bring it on, I would not know. I suspect that is unknowable. But I have had no such injury to either hand. The people that I talked to have not had it come back where it was resected. While it may appear in another finger, how is one to know if that would have happened anyway?
104 days after surgery. No complications, my fingers move fine. The surgical scar is not very noticeable. Tip of finger still feels a bit tingly but less so, and I don't notice it unless I think about it. I saw the surgeon today for a follow up and we are all very happy about the outcome. As I am an amateur violinist/violist and continue to take lessons, I have no basis for judging the affect of Dupytren's on my playing or the surgery. I believe I'll be playing longer for having it done. I continue to play better.
Out of curiousity, did the doctors prescribe Xiaflex for you (link below)? It's a newly approved medication for DP made by AUXL. I used to cover biotech companies on Wall Street and I had to study it before it was approved, and the results in clinical trials were pretty impressive.
https://www.xiaflex.com/
Wendel, this is wonderful. Do you have full range of motion, both directions? Congratulations on such a good recovery.
I had surgery May 3rd, and the 20+ stitches came out yesterday. It's all still quite swollen and stiff, but both the doctor and therapist are optimistic. Mine was the right hand, so I've had the unbreakable Coda bow rehaired and it's ready to go! String players must be the only bunch who would rather mess up the right hand than the left, other than southpaws, anyway.
Benedict, the cutoff for Xiaflex use is at about a 45 degree contraction, so Wendel may not have been considered a good candidate. The price of that stuff is a little alarming, too.
Yeah, it is expensive I guess, but it's an unmet need in a relatively small patient population and it works (at least by the data) pretty darn well for the population that can use it. So that's part of the reason it's somewhat expensive. Unfortunately, the smaller the patient population the more expensive drugs tend to be, because the costs of the R&D and testing needs to be recouped somehow. :( Glad to hear you're both doing well and back to what you love!
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March 14, 2011 at 02:04 PM ·
Best of luck... happy for you that it worked!