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Post-Op NA
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03/12/2007 00:50
bstenman 
03/12/2007 00:50
bstenman 
Re: Post-Op NA - Icing and elevation

There is a diagram in David P. Green's book on hand surgery that shows the use of two pillows, one below the arm and one on top sandwiching the arm which has a rolled up towel on each side, and the ends of the pillows pinned together. It is an expensive alternative to manufactured solutions. It seems like a large section of foam tubing, 8 inches (200mm) in diameter with a center opening for the arm would work more securely and be easier to put on and take off.

Any suggestions about solutions that have worked particularly well would be much appreciated.

Bruce

03/12/2007 23:26
Mark_D 
03/12/2007 23:26
Mark_D 
Re: Post-Op NA

Bruce:

At least after my own N.A. last August (a great job done by Dr. Denkler), I didn't need anything fancy at all.

I just kept my right hand elevated on a plain old pillow.

I can't imagine why anyone would need an expensive item to achieve simple elevation.

Hope this helps.

Mark


PS: The only real post-N.A. pain that I had resulted, it turned out, from my over-tightening the wrapping the night after the N.A. When I called Dr. Denkler the next morning, he said just to loosen the bandage, The relief from pain was almost immediate.

03/14/2007 16:56
bstenman 
03/14/2007 16:56
bstenman 
Re: Post-Op NA

Mark,

Thanks for the tip.

I had the NA performed by Dr. Denkler on Monday and by Tuesday morning the swelling was gone completely. Dr. Denkler does not recommend the use of ice at all. The first day the bandages get in the way, and from my experience the swelling was not an issue with either hand.

I used pillows under my arms and found that they also kept me from rolling onto my side which also helped with keeping the hands elevated.

I also read not to drink any alcohol as it can cause fluid retention which can affect the amount of swelling after the procedure.

The only thing I would do differently with the aid of hindsight would have been to wear sweat pants with an elastic waist band to the doctor's office for the procedure and purchase ahead of time straws for drinking fluids, and a box of latex gloves so when nature calls I could use the gloves and then dispose of them afterwards, not trying to wash my hands with the gloves on and then dry them off, peel them off and reuse them. For the cost of a box of 100 gloves it is not worth the trouble or worrying about contamination of the incision areas.

I am doing "push-ups" against a door to flatten my palms. Dr. Denkler differs from others in believing that this is very beneficial. He sites that individuals suffering from Ledderhose do not develop contractures as they are constantly stretching the tissue in their feet when they walk. Made sense to me.

Bruce

03/15/2007 01:57
Mark_D 
03/15/2007 01:57
Mark_D 
Re: Post-Op NA

Bruce:

Congratulations on getting your N.A. done.

We're both blessed to have had Keith Denkler do the procedure.

Dr. Denkler is one of my Dupuytren's Heroes.

I like your suggestions - if I ever have the procedure done again, I'll keep them in mind.

In fact, you might consider putting your thoughts in a new Topic -- titled something like "Post N.A. Suggestions". That would make your helpful ideas easier for people to find.

Good luck with your continued recovery!

Mark

Mark

03/30/2007 22:11
ademas 
03/30/2007 22:11
ademas 
Re: Post-Op NA

I had my NA procedure on Wednesday 03/28/07 (Dr. Benhaim @ UCLA)--can't say enough good things about the good doctor and his medical staff.

I can lay my hand completely flat (as flat as the dressing allows), although I'm not pushing it at this stage. It's still a little sore. I'm thrilled that my fingers are all functioning and straight, and I have full sensation back.

So...48-hours into this, and I'm dying to take a look and change the dressing. I think I'm going to head to the pharmacy now and buy what I need to do just that.

One thing I didn't ask the doctor (maybe some of you know): Once this is healed up, are stretching exercises helpful to prevent the cords from redeveloping?

Also, my Dupuytren's was brought on by trauma. I fell a few years ago on the stairs, and caught myself with my left palm. The first palmar nodule developed immediately...almost overnight. My right hand is completely unaffected.

I wonder if the incidence of reoccurence is any less when the Dupuytren's is brought on by trauma, as opposed to just having it develop due to a genetic predisposition? I come from an enormous family on both sides (yes...eastern European...), but none of my grandparents, or my dozen aunts and uncles, or my 60 first cousins, have Dupuytren's.

Craig

03/31/2007 04:49
wach 

Administrator

03/31/2007 04:49
wach 

Administrator

Recurrence?

Craig, you are asking a couple of good questions!

a) the issue with NA is recurrence. For some patients contraction doesn't come back for many years while for some the finger starts bending again within less than a year. Why so different? Don't know. There are proposals how to postpone recurrence after NA for a longer period of time but none is proven or established (by the way, recurrence also happens after surgery, though probably less likely. A 2nd NA on the same finger isn't any issue while a 2nd surgery though possible is far more difficult due to scarring). Proposals to postpone scarring are e.g. radiotherapy after NA (proposed by Keith Denkler), taking NAC for a couple on months (applied at University of Erlangen after surgery), wearing a comfortable night splint over 6 - 9 months (proposed by Albrecht Meinel). So far there is little to none experience with any of these. Each might help but we don't know for sure.

b) as your Dupuytren had been triggered by trauma will it be more likely that it won't come back? I don't know of any publication about that question so I here are my personal ideas: I tend to believe that there are fundamentally three groups of people: group 1 is immune to Dupuytren, group 2 requires severe trauma to get Dupuytren, group 3 gets Dupuytren already from mini-damages or inflammations. Which group someone is in is probably inherited. That might explain why you see Dupuytren in some ethnic groups very often (Scottish, Irish, French, Spanish, Japanese) and why it goes in families. In short, I don't believe your Dupuyten will come back quickly. Good news, isn't it?

Overall we don't understan why Dupuyten progresses fast for some and slowly for others. Last week on a conference a hand surgeon told the story of a colleague who is now 80 and has had Dupuytren in her right hand since the age of 50 but without contraction. It is pretty stable and does not require treatment. Three years ago she started to develop a nodule on the other hand which quickly turned into a cord and contracted. The same person, so that even rules out inheritance. The surgon concluded "I really wish I knew why that happened".

Wolfgang

04/13/2007 04:36
bstenman 
04/13/2007 04:36
bstenman 
Re: Post-Op NA

Craig,

Dr. Denkler, unlike some other doctors, believes in continued stretching of the hands. He sites the fact that people with lederhose get cords but not contractures due to the constant stretching of the tissue while walking.

I have been doing stretching of my hands since my NA procedure 4 weeks ago. I can't say that it has increased my range of motion, but I do not know if that range would have been reduced had I not been doing the stretching.

As doctors cannot agree it is clearly an unknown at this point in time.

04/13/2007 07:17
Wolfgang

not registered

04/13/2007 07:17
Wolfgang

not registered

exercise and cords

Bruce,

there is another explanation for the rare contraction of toes from Ledderhose. The basic idea is that the cords are essential for contraction (whether they do that actively or not doesn't matter in this respect) and that they develop as a response to pulling forces. Cords then develop in the direction of the pulling force (that's why the develop along tendons) and result eventually in a extension deficit.

The whole thing starts with a little benign tumor, a nodule. If that nodule grows in an area where the skin under normal conditions is very flexible and often compressed and strechted again (like the skin around your fingers' MCPs), the tumor will initially "glue" the skin to the nodule. Now the skin isn't that flexible anymore and when you use your affected finger a pulling force is applied onto the nodule. It then starts to develop a cord.

If the tumor starts in an area where the skin is quite stable and subject to little movement it will not develop into a cord but just keep growing. That's the case if the nodule starts e.g. in the arch of your foot where most Ledderhose nodules are. The same seems to be true for nodules in the lower half of the palm, i.e. towards the wrist, where the skin hardly moves.

If the Ledderhose nodule happens to appear more towards the toes it might also develop a cord and contract the toe.

That's the theory. True or not? Who knows. If it is true, stretching might be counterproductive. But there are also other aspects: it might be that regular exercise, like walking for feet or massaging for hands, works against the fixed skin and keeps it movable thus reducing the pulling force. It might also work similar to a splint. i.e. keeping the finger or toe in the right position and function.

So what's the conclusion? Try and see whether exercise does you good or not. We anyway know that everyone reacts a little differently ...

Wolfgang

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fundamentally   contraction   Post-Op   Elevated   over-tightening   inflammations   procedure   Recurrence   counterproductive   Dupuytren   swelling   difficulties   Congratulations   unrealistic   medications   Ledderhose   Denkler   stretching   develop   predisposition