Hi.my name is Stuart,I'm 42 years old and live in Scotland.I was recently diagnosed with Dupuytrens in my right hand.I can't fully straighten my middle finger,ring finger or pinky.Although my fingers are not bent to the degree of some pictures iv seen,I do get considerable pain at times if I accidentally press something in the palm of my hand or if I try to stretch my fingers back. I went to hospital last week and the specialist there told me I needed an operation.Only after getting home and doing some research have I learned about these injections which seem to be just as effective and don't have the 6 weeks recovery time etc.I just found the information about Dr Eaton in Jupiter Florida and now I am really not sure whether to go ahead with my operation here or perhaps consider flying to Florida to have it done.The weird thing is that I am actually in the process of emigrating to Florida (my fiancé lives there and iv been over many times) I just wondered if there is more chance of contracture s coming back with injections or is it just your luck?My doctor told me that it may come back even after an operation so it seems much more sensible to opt for the injections. Any advice would be very much appreciated.Thanks in advance.Stuart Ps.I did give the palm of my right hand a bad cut with a Stanley knife about 5 years ago and I was convinced that this was from that injury but the specialist said it had absolutely nothing to do with that injury?I will try put a photo of my hand on here once I figure out how lol.
Stuart; You will see that a lot of people on this site believe there can be a link between hand trauma and dupuytrens. I personally believe that dupuytrens may have two triggers (Like type 1 and type 2 diabetes) the first and most aggressive being genetic and the second being environmental. Environmental being hand trauma and lifestyle issues such a alcohol abuse and all the things that cause diabetes.
Unproven of course but a theory that I have developed to account for all those people that get dupuytrens later in life or following an accident and don't seem to have a family history of DD. The relevance of all this is that I think it should influence your choice of treatment.
First look around you relatives. If DD is prevalent then you fall into the genetic category and, it seems to me, that you are likely to end up with the disease recurring regardless of what you do. This is important as there is a limit to the number of times that you can have surgery. In the alternative if you seem to be the only one in your wider family that has DD then surgery could well be the best option for you. One operation and that may be all you ever see of the disease.
If you think you are in the genetic category my suggestion is that you view surgery as your last option. In this case I would start with one of the other treatments. Xiaflex is the option that you are looking at and it might be the best option for you but Xiaflex is still in its trial stage and it is relatively expensive. And, perhaps more importantly, you are in Scotland. Why not simply spend a day in Paris and get you fingers straightened with Needle Aponeurotomy (NA). You can read about NA on this site http://www.dupuytren-online.info/needle_aponeurotomy.html
I have been to both Dr Badois and Dr Manet-Cholin in Paris. You can send a photograph to either of these doctors and book an appointment without the need for a referral or prior consultation. The procedure will take about 20 minutes and costs about £200. Add on an Easyjet flight at £100 and you have your hand fixed for £300 and it only takes a day. You need to keep the hand dry and clean for 3 days and no weight for ten days and thats it.
Doctors will tell you that with NA the disease is likely to come back and it does seem to come back more frequently than with surgery but I don't see that this matters. A day in Paris every few years doesn't seem like a huge burden to me.
Welcome Stuart. Xiapex injections are available on the NHS in Scotland. But do some more research and as already suggested consider NA. NA too is available on the NHS, although the best skill is indeed most likely in Paris. Where abouts in Scotand are you?
Thanks for the info guys.There is no history of Dupuytrens in my family.When the specialist asked me this and I told him no...he had the cheek to ask me "are you sure"?..it was like he didn't believe me!I would rather get advice through people on here before I decide what route to take.Sounds to me like a one-off operation(although longer recovery)may be the best option.Im still relatively young and would hate to make the wrong choice.I had no idea until I joined here that some people have got it in their other hand soon after surgery!makes me wonder whether I should put up with it for as long as I can before surgery?Having said that,my hand is starting to curl inwards a lot compared with 2 or 3 years ago.It is also a lot more painful at times if I try using it in a certain way ie pulling or pushing levers at work.Do you guys think its better to act now,before my hand gets really bad.Does it make surgery/recovery more difficult the longer I wait?sorry for all the questions. I live in Grangemouth in Scotland,between Glasgow and Edinburgh.
Stuart; If you decide to go with surgery there is no urgency. If its not changing very fast you might be able to wait years before surgery.
For other treatment acting sooner tends to get better outcomes.
Unfortunately there is no right or wrong answer and you really have no choice but to make the best call you can for yourself. The medical profession is not much help here. No doubt your specialist is a hand surgeon and he may have a lot of experience with dupuytrens surgery but that doesn't make him a specialist in dupuytrens.
Of course you could always try NA and if the disease returns quickly you could then have surgery. The reverse doesn't work as the NA doesn't work where there is scar tissue.
Hi Stuart, Australia Calling. Unfortunately if you are diagnosed at a young age with Dupuytrens there is strong indicator that the disease could become aggressive. Do you have any Knuckle Pads on the back of your hand. I have had 15 odd surgeries and in my case I believe that each surgery kept the clock ticking and reduced the time span leading to the following surgery. There was no NA or radiotherapy years ago Down Under. I would recommend NA with no down time. The cost in the US is out of this world . I believe Dr Eaton is no longer practicing medicine. It is not practicable to have NA on the same area after surgery due to the scar tissue.
You are misinformed if you have been told a one off operation as in meaning that is the end of it. Maybe so, chances are better if done with skin graft, but even so maybe not. The usual recommended path of treatment is minimally invasive first. Also who told you six weeks recovery? Possible but on the optimistic extreme end of the bell curve for recovery rates. If after reviewing all the good and bad stories on here about surgery you decide to go this path first, make sure the surgeon is also one who has extensive experience with Dupuytrens. Not a plastic surgeon, not an orthopaedic surgeon, not a hand and wrist or upper arm surgeon but a hand surgeon with extensive experience and success with treating Dupuytrens. Take a bit more time and do the research and ask questions.
My suggestion is to give NA a try first. I would go with surgery, but that is only because it was such a great success with my finger (90 degrees contracture before surgery, and now zero degrees contracture eleven years later). The optimum time for surgery is anywhere from 30 degrees to 60 degrees contracture. Many (medical people) will tell you to wait until then because for so many people that is all the further the fingers might contract and many people just live with it rather than do any procedures.
The recovery time for surgery kind of depends on what you do with your hands. I was driving a couple of days after surgery, but not golfing for a couple of months. For some people recovery doesn't change their life much at all. An attorney friend had little problem with the recovery. If you use both your hands in physical employment if can be a problem.
Thanks to all you guys for your advice and your own personal experiences.I appreciate that no two cases or outcomes will necessarily be the same.just wanted a general feel for what's best for me.
Now I have found out that some early stage sufferers have had radiation therapy.Does anyone on here know of anyone who has has this treatment and its success?
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