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Post operative therapy
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12/26/2007 20:31
jim_h 
12/26/2007 20:31
jim_h 
Re: Post operative therapy

Immediately following the surgeries I was sent to a physical therapist. In fact, the PT group specialized in hand injuries and was associated with the hand surgery clinic. I then went to bi-weekly PT sessions for at least a couple of months. This is standard procedure for Dupuytren's surgery here in the US, when performed by a CHS.

Besides massage, ultrasound (to reduce scarring) and measurements, the therapist assigned me a set of exercises and emphasized their importance if I was to regain something like full range of motion. They also gave me silicone 'scar pads' to reduce scarring, and compression dressings to combat swelling I performed the exercises dilligently for months and I believe they're absolutely critical If you do nothing, you won't get anything like the ROM you will regain with exercise.


My advice to you is to find a physical therapist with this experience, even if your surgeon isn't involved, and even if you have to pay out-of-pocket.



12/27/2007 06:03
rosco 
12/27/2007 06:03
rosco 
Re: Post operative therapy

Jim, thankyou for your response, it further supports the need for a serious PT regime. I am now quite alarmed as to why I was not been directed to a structured therapy program, and will certainly be taking this up with my surgeon at our next encounter (unfortunately, not until the end of January). I now note that there are examples on the web where Aussie surgeons do prescribe ongoing post operative physio programs, though virtually nothing is given on individual program content or dispensing locations.

Still, that's in the past now, and I did have the opportunity to ask questions before the surgery, so I have to shoulder some of the responsibility for being ill-informed on this occasion.

On a positive note, I have already taken things into my own hands (excuse the pun) and started my own exercise program based loosely around some of Diane's earlier feedback. Already I believe I am seeing some benefits, no doubt its more in my mind than physically in my hand, but the discipline of setting a structured exercise regime appeals to me greatly, its good for morale. In fact, I am now lot limiting it to my recovering left hand, but after reading through many of the posts in this forum, I have decided to commence stretching exercises in my right hand to hopefully avoid future surgery. In true Ozzie style, I will either heal it or break it.

12/30/2007 04:01
newman 
12/30/2007 04:01
newman 

Re: Post operative therapy

Australia Calling /Adelaide.
Rosco you certainly had a bad experience for a Private Patient. I 've had many surgeries and concur with Wolfgang you will need time. Exercise is important but gently does it ,you dont want to break the scar tissue and have a keloid develope. At night apply enriched Vitemin E or Eurea creme or even Vasoline and wear a white washable cotton glove to keep the skin tissue soft. Try obtaining a putty like plastercine material from the physio . You place it in your palm and squeeze the hell out of it a few times a day ,which helps build up strength and mobility. I still exercise daily and have good mobility.
I have just returned from Germany having had radiotherapy . I am in dialogue with the Government Hospital and Private Oncology to have Radiotherapy offered In Adelaide. Finally where are calling from. Regards.

01/01/2008 19:38
rosco 
01/01/2008 19:38
rosco 
Re: Post operative therapy

Newman...thanks for the advice. I find the tissue surrounding & beneath the scar line is most swollen and stiff of a morning. Even after several weeks of applying creams and exercising, I wake up to the same sensation in the hand. It feels as though I have a lump of plastic grafted onto the palm of my hand...and takes several hours to restore full mobility. I think the skin tissue is also drying out of a night, hence the addition of the cotton glove may assist.

I still don't fully understand what is happening in respect to the healing process. It does not seem to respond to normal therapies? For instance, swelling in a normal soft tissue sprain reduces overnight, particularly if you elevate the limb. However, this DC wound site actually swells overnight, and appears to get worse due to the inactivity? Hence, all my traditional attempts to improve appear to be going in the opposite direction? Obviously there is a world of difference between a soft tissue sprain, and tissue recovering from trauma following an invasive operation. My assumption is that the swelling I am experiencing overnight is in part due to a reduced blood flow to the scar tissue area. Exercise of a day apears to stimulate this area resulting in improved circulation and tissue flexibility. I probably have this all wrong, which illustrates the dangers of self diagnosis.

Finally, as to location, I am in Newcastle. As I stated in this forum back in mid 2007, we have an excellent Oncology unit located here with no end of expertise in Radiotherapy. I believe they also have research contacts attached to the medical faculty at the local university. But it seems that surgery is the only accepted option around here. One thing is for sure, I will not be subjecting my right hand to the same surgical procedure without exhausting my understanding of alternative options.

01/02/2008 23:13
newman 
01/02/2008 23:13
newman 

Re: Post operative therapy

Hi Rosco ,Each of us experiences different symptons and I must say in my case each surgery reponded differently.Try at night keeping your hand elevated on an extra pillow above your heart line. This will reduce the night swelling. During the day , at times extend your hand above your head moving the fingers like playing the piano and gently ,but quickly closing and opening the hand .( Remembering its the smaller veins that returns the blood supply .)Do this as often as practical . A final point, when you are sitting down or relaxing try and keep you hand high resting your hand on the shoulder. In this early stage I believe the more of these simple exercises helps with the healing process. The hard swelling you mention, I 've experience and as mentioned you need time. Go to the beach and relax, Swimming is great using the resistence of the water to strengthen the hand.
Could you let me know the name of the Oncology in Newcastle and any contact phone numbers as I am endeavouring to get radiotherapy expanded for other patients. I picked up you have problem with MD in the other hand . Radiotherapy is most beneficial in the early stage when you have just the nodule.Regards from across the border.

01/03/2008 07:20
rosco 
01/03/2008 07:20
rosco 
Re: Post operative therapy

Thanks again Newman for the advice, I will put into practice as I am looking for any way I can to make a speedy recovery (and return to golf!).

As for the address of the local oncology unit attached to the Newcastle Mater Hospital (Waratah), perhaps the best link is the following:

http://www.mater.net.au/

The hospital houses the main Oncology unit for the Hunter region, and I believe is very well respected nationally. It would be a great asset to the local community indeed if this facility could undertake radiotherapy for the treatment of Dupuytren.

01/03/2008 13:42
Ceri Small

not registered

01/03/2008 13:42
Ceri Small

not registered

Re: Post operative therapy

Rosco,

I had surgery here in the UK on 23rd June 07, and experienced roughly similar results, in that the wound took a few weeks longer to heal (due to infection) and had thick scar tissue. I started physiotherapy after two weeks when the wound started to heal. They basically told me the more I used the hand, the better it would get. Exercises were recommended as per Diane's email. Also, one of the tips I was given to reduce scar tissue was regular exercise WITH HAND CREAM - here in the UK we have a cream called E45 and some versions of it do say on the tube that it helps healing of scar tissue. I started massaging at least twice a day after the wound had healed.
Now the good news - I'm also a keen golfer, and started playing three weeks after the op, even though the hand was nowhere near functional. I could just about grip the club, and due to lack of strength in the hand balls were flying everywhere (some would say pretty normal for me!). But I kept persevering - the only warning I'd give is be careful not to hit too much of a "fat" shot and jar the hand, and don't be over-ambitious in the rough.
Within two months, I was fairly back to normal. The scar has now healed to a thin line of normal thickness.
Six months on, I can just about make a fist. I say just about, because after the op my little finger could not bend completely due to the flexor tendon losing flexibility whilst bent.
I had a further op to correct this on the 12th December, and physio is now helping me to use the hand fully. I played within 10 days of the op.
Moral to the story - keep your chin up! Best of luck.

01/03/2008 13:51
Ceri Small

not registered

01/03/2008 13:51
Ceri Small

not registered

Re: Post operative therapy

Sorry Rosco - one more thing. Part of the Physio process that were invaluable to me were the silicon scar pads and compression tape that jim h mentioned. I found that putting these under my splint at night speeded up the healing process greatly. You could try looking for these yourself if you can't see a physio until later in the month.

01/03/2008 22:38
rosco 
01/03/2008 22:38
rosco 
Re: Post operative therapy

Thanks Ceri for support..particularly from a fellow golfer.

I have a selection of vitamin E creams & oils that I am using on the hand, pretty much from the first minute I awake each morning. After 30 minutes of manipulating the palm of the hand, I am now able to form a reasonable fist. However, the palm remains very swollen and numb below and adjacent to the scar line.

If I then maintain a regime of exercising the hand for say 1 - 2 minutes every 20 minutes, I can maintain reasonable flexibility throughout the day. At night, the hand stiffens up again (seemingly regardless of elevation etc), so I repeat the whole cycle the following morning.

If I was not a golfer, then you would probably say I am have made a reasonably recovery. Put a golf club in my hand, and it is a totally different story with reduced grip strength due largely to uneven grip pressure across the palm due to swollen tissue around the scar line. It feels like hitting the ball wearing a thick, stiff leather gardening glove, absolutely no feeling or control.

BUT, the lesson I have learnt from this forum is to be patient, maintain the exercises, and if possible, seek professional physio advice. In the interim, until I return to the golf course, I have installed a Dart board!

Good luck with your recovery, and I hope your return to golf is successful

01/14/2008 08:13
rosco 
01/14/2008 08:13
rosco 
Re: Post operative therapy

Thought I'd give a bit of an update. Coming up for 8 weeks since surgery, hand now healed (at least superficially), but still significant localised soft tissue swelling around scar. Still takes some 45 to 60 mins each morning of massaging the hand and fingers using Vitamin E cream before I can make a fist. Usually requires significant assistance from other hand to coax fingers to close (theskin around the scar feels literally as stiff as cardboard first thing each morning). But, once achieved, the hand remains reasonable flexible for the remainder of the day. Sense of touch has still not returned to area surrounding scar tissue or base of ring finger, but I am getting more use to it.

I belive I previously read in another posting on this site that from 5 weeks on after surgery, it is not uncommon for 'phantom' pains to start up, particularly along the scar line. Such is certainly the case. For no apparent reason, a sharp sensation akin to having a pin or knife jabbed into the scar and surrounding tissue lasts for some 5 to 10 seconds, then subsides. It does not necessarily occur in the same place. Instead, it appears quite random at times. Not regular either, can occur several times in an hour, then disappear for several hours. Assume it is associated with the repairing of the nerves surrounding the incision. Probably better that I feel some rather than nothing at all.

Not much more I can add at this stage, except to say it is (as other have told me) a long road to complete recovery, and it pays to be persistent, but patient. No sign of any chords reappering at this stage, but it is still very early days.

For all the golfers out there, I managed to play to my handicap with a gross 81 in competition two days ago. Very pleasing since it is only my second game back since surgery. It still feels like I am swing a brick at times, but I feel very thankful to be circulating in the fresh air. Thanks to those who assisted my journey with their much valued advice.

TextFinally, I note that the icon beside this posting back on the Forum page is a blank page with what looks a either a red magnet or horseshoe superimposed on it. What does this mean? If I am breaking any forum protocols by continuing to build on this posting, then I best be advised.

Edited at 14.01.08 10:30

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