There are somewhat rare cases where the joints of the fingers closest to the trauma from the surgery swell quite a bit after surgery. This regardless of the post op PT. I had two rounds of hand therapy because my hand was still so stiff. Finally my surgeon admitted that the swelling and stiffness of my hand was "off the chart".

To this day (five years later) I have found nothing that can be done about this. I believe things may be improving a bit and hope that in 10 years or so most of pain and the normal functioning of my hand will return. I will *never* submit to additional Open Surgery under any circumstances.

NA on the other hand (quite literally) has bee a God send. One NA was performed four years ago and I have had no further problems.

My story is of no consultation other than the fact that you are not alone. Still, it does sound that you also did not get enough PT. I went 3 times a week and it was hell. At least I can push through the stiffness and get 90% range of motion, but not without the kind of pain that makes me grind my teeth. I consider my hand 30 to 40 % crippled.

The side effects are not from the surgery so much as from starving the cells with the use of a tourniquet for the entire limb during the 90 minute long operation. Dr. Denkler has been advocating for years the use instead of arterial clamps but even with evidence covering over 4000 hand surgeries the medical profession has been reluctant to change how it operates. Different people, different durations of surgery, and different tourniquet procedures, all play a role in the outcome and probability of serious side effects after a facsciectomy.

Equally important is having an excellent physical therapist with specific knowledge and experience with fasciectomy patients and rehabilitation. I would want to talk to the therapist before undertaking the operation, in part to see if I could learn if patients operated on by a particular surgeon tended to have shorter recovery times and better outcomes.

For swelling in general the use of an ice pack for 15-20 minutes will reduce swelling, alleviate the pain, and promote healing (as the swelling interferes with circulation necessary for the bodies recuperative processes).

My experience in dealing with health practitioners over the years is that few are involved with anything pertaining to post operative care and the impact on patient. If the procedure is successful and they will get paid and not sued, that is as the end of it for most - and having health care managed by insurance companies and profit maximizing bureaucrats as it is in the USA makes this tendency even worse.

Hi fellow sufferers

Thanks for all your replies, views and advice.

Physiotherapy turned out to be more splinting of the palmer variety (which keeps my wrist in extension) in an attempt to straighten my little finger and the one next to it. This form of splinting seem to rely on the effectiveness of me tightening the strapping attached to the splint by Velcro which I have to wind around the splint (and the affected fingers) which is divided between the 2 affected fingers, in order to bring my finger into the shape of the splint. I am on to my second splint of this type. So far there appears to be little effect.

I have to go back for a review by the therapists in mid May (also I may get another course of ultrasound treatment) and a week later I see the Consultant again for his review.

The affected fingers are still very swollen and prevent me from making a fist due to limit ability to flex the joints of these two fingers, whilst at the same time the joints in these fingers apart from the distal interphalangeal joint of my little finger which now has full extension, are still contracted. This is despite massaging the hand and fingers with aqueous cream, and exercises as specified by the physiotherapist to flex and extend the joints of the affected fingers.

I was told by the therapists that it may be a year or morepost op that the swelling in the fingers diminishes.

I still have a limited range of movement in my wrist.

Following the next meetings with the therapists and consultant, I will consider asking my GP (I live in England by the way) for another medical opinion.

Regards

Richard

Interesting abstract but it doesn't say where it is published (except on the dynasplint web site). I wasn't able to find it in PubMed. Also interesting that the results don't mention the PIP joint anymore.

Wolfgang

I've been through somewhat similar surgeries twice. Swelling is normal and takes months to resolve. Re-opening of the wound is also common; it is healing from the inside out, so it continues to look alarmingly bad even though serious healing is in progress. Keep doint the exercies to the max, and make sure the splint is doing its job. You may not get optimal recovery if PT has been skipped, but you may end up with significant improvement in the end. Repair of the 5th finger PIP joint is seldom completely successful. I was also at 90 degrees and even with full PT and splint, within 2 years I'd lost most of what I'd gained from the surgery. All they can do, with this joint, is try their best.