| Lost password
631 users onlineYou are not loggend in.  Login
Post operative therapy
 1 2 3
 1 2 3
12/23/2007 23:31
rosco 
12/23/2007 23:31
rosco 
Post operative therapy

After consulting this site on numerous occasions early in 2007, I decided to proceed with surgery to remove the DC from my left hand. There were few alternative options for me in Australia unless I could travel to Melbourne or Perth for NA or radiation therapy, both of which were very much in their infancy in this country at the time. I must say in hindsight, I wish I had thought it through a little more.

Four weeks on from surgery, and I have a long largely healed scar from the base of my left palm, straight through to the base of ring finger (no zig zag as per the classic approach), and a wound extending from the base of the ring finger to the first knuckle that is very slow in healing.

My disappointment in the result stems from an inability to close my fist. I appear to have a large amount of thickened (numb) skin tracking both sides of the scar on my palm that refuses to undergo compression when I close my hand. Add to this that any attempt to form a fist normally results in the opening of the wound at the base of the ring finger.

My hand is most stiff and the scar tissue most swollen of a morning. It takes several hours to loosen the skin up even a little.. I have tried various creams and exercises...but the thickened tissue seems to be largely unresponsive. It has crossed my mind that I may be in fact worsening the problem by agitating this tissue so aggressively...but again I can't find any clear guidelines on this.

I have scoured the internet (and this site) to find post operative therapies that may assist in reducing this formation of thick scar like tissue...but to no avail. Instead, I have every reason to believe that this thickening is probably not too dissimilar to the underlying root cause of DC and some other related deseases. I found it particularly interesting in the high incidence of DC and related deseases such as frozen shoulders. I have had both shoulders operated on in the past three years; both were virtually frozen solid.

I am now pondering if I will proceed with the DC surgery to my right hand...I have serious doubts about the long term benefits. Perhaps only time will tell; any feedback would be greatfully recieved.

12/24/2007 01:05
jim_h 
12/24/2007 01:05
jim_h 
Re: Post operative therapy

I've been through this, twice. Don't get discouraged. At 4 weeks, it looks pretty bleak, because you're thinking that things should look much better by now. Real recovery takes months, and if your surgeon didn't make that clear, he was remiss. The swelling and the stiff, hard tissue will respond to PT, but very slowly. The exercises are important even if you feel you're making little progress at this time.

Surgery works, it's just a much longer and harder road than NA.

12/24/2007 05:37
diane s

not registered

12/24/2007 05:37
diane s

not registered

Re: Post operative therapy

Jim is right, it will be another month or two before you feel like you have turned the corner, but you will. Physical therapy can help loads and I hope you are getting some or surgeons instructions.

12/24/2007 06:26
Randy_H 
12/24/2007 06:26
Randy_H 

Re: Post operative therapy

Part of your problem is swelling from the invasiveness and trauma of the surgery. Take 800 mg of ibuprofen 3 x day. Discontinue after a few weeks and see what effect it has had.

I have one surgically treated hand and one done with NA. I recommend you consider the same path.

Keep up the PT. Things will improve.

12/24/2007 07:22
wach 

Administrator

12/24/2007 07:22
wach 

Administrator

Re: Post operative therapy

I went through the same experience after surgery. It took me 4 months until I could make a fist again without support from the other hand. Today, about 4 years after surgery still no recurrence and my hand is fully functioning. It's not the same as before surgery, mostly due to the scar and the fact that a part of the aponeurosis was removed as well, but I got used to it and my hand works well. So don't dispair, as mentioned in the other posts, it takes its time.

My understanding is that people react differently to surgery. Some might have restricted blood flow in their arm's veins which is no problem under normal conditions. But after surgery the hand get swollen and that can block making a fist. In my case it took about 6 months until my operated hand wasn't thicker any more. I am sure there are also other conditions that might hinder making a fist. But PT helps. Eventually, when your scar is stable you might also consider soaking your hand in warm water for 5 - 10 minutes a day and slight massaging.

Good luck to you

Wolfgang
PS: I agree with Randy: why not give NA a try? Not much to lose with NA. There is a very slight chance for tendon rupture and recurrence is probably faster but recovery is much, much faster.

Edited at 24.12.07 09:23

12/24/2007 19:24
rosco 
12/24/2007 19:24
rosco 
Re: Post operative therapy

Well, its Christmas day morning here in Australia, and as per the routine of the last few weeks, I am awake early before my wife and daughters, dispairing in the loss of function in my left hand.

That was until I read the replies to my posting of yesterday. Thankyou to those who took the time to respond. I have drawn a great deal of hope from your words. The truth is that I am an avid (some would say fanatical) golfer who is greatly missing the sport I have actively pursued for over 40 years. The importance of forming a fist is so that I might adequately grasp a golf club, nothing more. I am now sure from your comments that hand function will return in time, but perhaps a little longer than I had first hoped.

I have every faith in my surgeon, he was the same chap who operated on my shoulders with great success. But, I must say he has not provided much in the way of instruction in the two very brief followup visits. His main concern seems to be keeping my ring finger as extended and straight as can be. No mention of any exercises as such, certainly none that would aid strengthening the hand. I do not see him now until a further 4 weeks time (its the holiday season here in Australia).

Is there any information or web sites available that provide instruction on exercises post surgery? I have found very little, other than basic statements around the need for such exercise and various references to massaging the hand...but nothing I can translate into a set exercise program. In the absence of such information I have invented my own...albeit somewhat basic.

Again, thankyou to those who responded.

12/24/2007 20:02
Randy_H 
12/24/2007 20:02
Randy_H 

Re: Post operative therapy

rosco

The importance of post operative hand therapy given by a trained physical therapist cannot be overstated. It is standard practice in the US. In fact CHS usually have their own authorized group of therapists they use. Frankly that your surgeon did not sign you up for that concerns me. Is he a Certified Hand Specialist? He's left you in the lerch, so I doubt it.

12/25/2007 22:47
rosco 
12/25/2007 22:47
rosco 
Re: Post operative therapy

Unfortunately I don't think many (if any?) surgeons in Australia are CHS compliant. A quick web search within Australia for such accrediatation turns up nothing...the same search in the US domain produces many hits.

I was briefly introduced to a physio the morning after my surgery, the same chap who provided instruction following my shoulder surgery some few years before. Basically though, no particular POT was prescribed beyond using the hand as much as possible.

I don't wish to name any names or institutes in this forum, but frankly I could right a book on my recent experience. Booked into a private hospital with full hospital cover, it turned out they did not have a room for me...so with 6 other males and females we were put up in a makeshift ward with a couple of tables thrown in for the nurses to sit at. There was no phones, no television, no walls, no convenient toilet or showers. I ended up sitting up all night in a lounge chair in the day ward recovery unit watching TV to escape the chorus of snoring from my poor fellow inmates. During the early hours of the morning my wound openned up, resulting in several calls by the nursing staff to my surgeon. The ring finger turned a deep purple, was stone numb, and cold to the touch. In addition, my bleeding hand managed to drip all over their waiting room carpet. By the time the surgeon called the next morning , he was in no mood for small talk. He subsequently visited the hospital's CEO to demand answers, but the predictable response was that such ward conjestion had never happened before in 15 years of operating the hospital. Funny, but that was not what the poor nurses had to say.

Anyway, I digress, and I would not like you to think all Austrlaian surgical experiences are like this..they are clearly not.

Still, if anyone can point me to a web site that contains some insight to hand exercises...I would be most appreciative.

Just on another point, unfortunately many people cannot take Ibuprofen, particularly if they are like myself and on stomach medictaion like Losec. Pity really, because I think its anti-inflamatory properties would assist me greatly... but there it is.

12/26/2007 05:49
diane s

not registered

12/26/2007 05:49
diane s

not registered

Re: Post operative therapy

Rosco
Yikes, what an unpleasant surgical experience. Sorry you had to go through it.

You asked for information on physical therapy. I am not a doctor or anything remotely close. But I did get physical therapy after an open surgery on my finger. Here are the things they did:

- prescribed flexion exercises which were bending my wrist, mcp joints (where fingers connect) pip joints in a couple of ways each for 20 repetitions , to be done 5 times a day. Hard to describe without a picture but sort of like waving your hand at the wrist joint, then at the mcp joint, then at the pip joint and so on. sort of the way a child waves. if i couldn't bend a joint i would push it a bit with the other hand. also bend fingers down toward palm in straight position and then again in curled position.

- alternating hot and cold whirlpool baths up to my elbow; something like 5 minutes in the hot bath, 2 or 3 in the cool , and then back to the hot. overall this was for 20-30 minutes. the hot/ cold contrast supposedly improves blood flow.

-a sort of electrical stimulation with a stylus after putting a lubricant on my hand. felt weird. didn't like it.

- dip hand in warm parafin then wrap it up in a cloth to hold heat in and let it stay warm for quite a while.

- after this stuff the therapist would work on my finger to push it straighter. , measure contracture, give a grip strength test and so forth.

again, i am not a medical person - just reporting my experience.

12/26/2007 09:40
rosco 
12/26/2007 09:40
rosco 
Re: Post operative therapy

Thankyou again for your feedback Dianne...your description of the therapy you undertook was just what I was looking for. In particular, the range/duration of activities to which your hand was subjected. I am not sure I will be able to find a local professional resource capable of replicating the entire therapy you have described, but I suspect I could replicate the first two activities myself, or at least give them a good try.

It is becoming even more apparent to me that the treatment of DC (or MD?) is a far more specialised practice area in both Europe and the US compared to Australia (my presumption is that you are not from 'the land down under'). This extends to both the range of treatment options (particularly non-surgical), and the heavy focus on followup therapies. But at least I now have something to go on. Many thanks to you and this forum.

 1 2 3
 1 2 3
Physical   anti-inflamatory   exercises   particularly   surgery   morning   surgeon   treatment   swelling   Australia   Unfortunately   therapist   surrounding   operative   therapy   recovery   exercise   experience   radiotherapy   physiotherapy