I have had evident and growing nodules in my right hand (dominant) for slightly less than two years. I have begun to notice that my hand is stiff when I awaken. I must manipulate it to allow it to close into a fist. This seems counter to what I was told, that I should consider treatment when I could not place my hand flat on the table, i.e., that flexion and not contraction is to be monitored. Have others noticed this phenomenon?

A little in coming, just got diagnosed, but yest, I find it hard to make a fist just after I wake up in the mornings. I can open my hand up, but the finger most affected - left middle finger (left-hand dominant) is curved while all the other are straight.

Jackie

This is a possible and probably the most likely reason: a consierable number of people have more or less constricted arm veins (stenosis). That's usually not an issue and they don't know about (my undersatnding is that 10 - 20 percent of the people have that). But when you have hand surgery the now much bigger amount of blood has difficulties to flow back from the hand and consequently the hand swells. How much and how long varies, it could go away in a week or take months. In my case it took me several months before I could make a fist again but eventually everything worked OK. In any case I would suggest to consult with a doctor because there might be other reasons and if the swelling stays for a very long time it might affect the functionality of the hand. What can you do to support it? Soft massages, drainage, holding the hand up, that's about all I know.

Here is the abstract of a paper that was published a fairly long time ago but became popular (original in German).

"The Significance of the Subclavian Vein Stenosis in the Treatment of Dupuytren's Disease"
A. Wilhelm und D. Englert, Handchir. Mikrochir. Plast. Chir. 21 (1989) S. 66 – 71.
Abstract:
The postoperative healing in cases of Dupuytren's contracture is not only influenced by the age of the patient and the progress of the disease, but also by the existence of other accompanying diseases and general and local factors. The appearance of postoperative edema and the so-called hand-finger-syndrome are especially
unfavorable, because these complications determine the duration of treatment and the functional results.
As a cause for these postoperative complications a disorder of the subclavian vein could be found and
documented by means of phlebography. Preoperative examination of the venous situation is therefore an
important diagnostic step to determine indications and to allow an estimation of the postoperative course and the
duration of treatment. Demonstration of cases and statistical evaluation of our patients over the last five years show the importance of this observation."

Darlene:

I broke my wrist 7/9/06--both bones and had surgery which involved plates and screws. My hand also swole up to epic proportions. (The O.T. had never seen such swelling--and she's been at it 20 years!) The doctor left my hand arm in a cast for 2 months, which I think made things much worse. It took 10 months of therapy and work at home to get most of the use of my left hand back. And it is not completely back. Also, during this time I discovered I had RSD (reflex sympathetic dystrophy). This made things much worse as I was not getting proper circulation to the hand. I was truly despairing of every getting better. Then, after the RSD diagnosis, I was given a shot of marcaine in the neck (gangleon block, I think) by a local anestheologist and it made all the difference. The color came back to my fingernails and the swelling really started to go down. Unfortunately, that was in January. So, I suffered with a pretty useless arm/hand from July to January. I was also told by that doctor to NEVER get that hand very cold--which is when I first noticed the symptoms of RSD--after the ice pack at therapy. I NEVER ALLOWED ICE after the first 2 visits; but the damage was done.

The "vain but sad" part of all this is that my skin stretched so much that my left hand now looks much older and wrinkled than my right hand. Not much I can do about that. Just glad it works as well as it does.

I doubt the swelling had anything to do with DC, which you probably did have before it all occurred, but it can't have made it any better and may have allowed the DC to get more control over your fingers.

My suggestion: Keep up the O.T.; check out the gangleon block; and consult with Dr. Benhaim at UCLA about the DC. Hope this helps.

Carmen, your swollen hand must have been very uncomfortable and I am glad you recovered! I myself had Dupuytren surgery and my hand stayed thick for about two months but eventually, and luckily, recovered more or less by itself. Later I learned that some people have constrictions in their arm veins. Those are not an issue under normal conditions but after an accident or surgery this can result in a swollen hand and a much longer recovery period. Extreme cases can even require amputation. Such constrictions are not very rare (about 5 %?) and can actually be diagnosed prior to surgery though that is not done regularly because it is too expensive.

Now that your hand recovered you are probably OK and don't need to worry about it anymore. But should you require surgery on that hand again you might face the same problem and it might make sense to mention it to your surgeon (which you would have anyway, I guess).

Wolfgang