DMars:

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Hi everyone,

I am due to have a palmar fascietomy on the NHS.

I have quite bad DD but in my left hand, but I am luckily right-handed so it does not cause me much trouble and has never been painful. I can still manage perfectly well to hold a glass and carry bags etc.

Basically, I have been reading up on the possible (and almost likely it seems) side effects of the surgery and I am seriously considering cancelling it. If I leave it I know it will continue to develop and it is starting in my right hand too (my father had it in both hands) so at some point surgery may be necessary, but would I be making a mistake in letting it get worse now?

I would really appreciate some advice!

Thanks.

How about nodules? Have you looked into NA/PNF for straightening the bent fingers and discussed this common solution with a doctor?

http://www.dupuytren-online.info/needle_aponeurotomy.html

DMars:

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Hi Stefan,

I have two cords, one from the palm to my middle finger and up to the knuckle and one from my thumb to the middle finger. My middle and 4th fingers are at about 45 degrees. Hope that makes sense!

I can't afford the injections which are not available on the NHS where I am.

The odds of getting sound accurate information and advice from a medical professional is slim to none when it comes to Dupuytren's in the USA and it sounds like the same is true in the UK.

Fasciectomy is not something one should consider until they have had a combination of Xiaflex and NA performed on the hand. These two procedures are much more effective and longer lasting if done together with Xiaflex injected on the first day and then NA performed the following day.

Fasciectomy entails a 60 to 90 minute procedure where a tourniquet is applied to the arm the entire time. There is frequently nerve and muscle damage as a result of this period with no blood flow to the arm and hand. The damage can often be permanent. In the USA it is rare for surgeons to care about the long term outcome for their patients. I asked two surgeons about the physical therapy needed and duration for full recovery and neither of them had a clue and both lied about the 5-6 percent chance of losing the function of the hand permanently (and these stats are published and available to the public).

Best case with a fascietomy is regaining full use of the hand after a month and more likely it will take several months of physical therapy. Often after 30 days a patient will not be able to squeeze a tennis ball. With Xiaflex and or NA you have immediate use of your hand and it is only recommended to wait 48 hours before bathing or showering or to use plastic gloves while doing so to keep any incisions free from possible infection.

NA entails risk to nerves in the hand and that is why a combination of Xiaflex injections where nerves run and a day later using NA to complete the process is much safer and a great deal more effective and much longer lasting than either procedure alone.

As the Xiaflex works over a 12-hour period the manipulation is going to be the following day at the earliest. While the manipulation is done with a local anesthetic first injected into the hand, having a knowledgeable hand surgeon do the NA at the same time takes only about 15 minutes longer and entails no additional cost for the patient.

Since my last series of Xiaflex injections followed by NA in November of 2013, I have been symptom free now for close to 4 years. I can still lay my treated hand down perfectly flat on a table with no effort which was not the case 4 years after my first NA operation done before Xiaflex was available. With my first NA procedure I had the same level of contracture after 3 years as I had before the NA.