Cedar Valley Hand Surgery

After surgery instructions for patients »

What is Dupuytren's disease?
Dupuytren's disease is an abnormal thickening of the palm that limits movement of the fingers. In serious cases, a cord forms beneath the skin that stretches from the palm to the base of the fingers. The cord may cause the fingers to bend into the palm so they cannot be fully extended. Sometimes the disease will affect other areas of the body, such as the knuckles of the fingers or the soles of the feet.

What is the cause of Dupuytren's disease?
The cause of Dupuytren's is unknown and there is no permanent cure. But, the disease is harmless and usually painless.

Who gets Dupuytren's disease?
Dupuytren's disease most often affects white people with ancestors from Northern Europe. It occurs more often in men than in women and usually starts after age 40. In many cases the disease runs in families. It is also more common in patients with diabetes, although it is usually not as progressive in these patients.

Some people may develop a more severe form of Dupuytren's disease. These may be people who:

Develop the disease at a young age.

Have the disease in areas other than the hand.

Have a history of liver disease caused by alcohol abuse.

Take medications to stop seizures from occurring.

Have had injuries to the hand.

What are the first signs and symptoms of Dupuytren's disease?
Dupuytren's disease usually shows up as a small lump or pit in the palm. This tends to occur near the crease of the hand that is closest to the base of the ring and little fingers. With time, the cord may develop between the palm and the fingers.

The disease is usually noticed when the palm cannot be placed flat on an even surface, such as a tabletop. In severe cases, drawing of the fingers into the palm interferes with everyday activities like washing hands, wearing gloves, and putting hands in pockets.

How does Dupuytren's disease develop?

The disease most often begins in the palm of the hand at the base of the ring or little fingers.
The lump or pit may show up months or even years before the cord develops from the palm to the fingers.
Having the disease in both hands is common.
Drawing of the fingers into the hand can occur at the joints at the base of the fingers or the joints in the fingers.
The skin may be involved with the disease, but the actual tendons in the hand are not affected.

What is the treatment for Dupuytren's disease?
There is no permanent cure for Dupuytren's disease. Exercises, splints, and oral medications are ineffective. Surgery can relieve the bending of the fingers into the palm, but the condition can return with time. The goal of surgery for Dupuytren's disease is to restore normal hand movement. Your doctor should advise you on whether surgery is recommended in your case.

Active research is being done on other methods such as enzyme injections. These injections are not yet available for our use.

Some considerations on surgery:

Presence of the lump in the hand does not mean that surgery is required.

Bending the fingers into the palm at the base of the fingers is usually correctable by surgery.

Surgery may not completely relieve bending of the fingers at the joints in the fingers.

It is important to remember that surgery is not a permanent cure for the disease. After surgery thickening of the palm and development of the cord may return in the same place or at a new place within the hand. Surgery is done as an outpatient procedure. A significant commitment to therapy and splinting after surgery is required.

After Surgery Instructions - Dupuytren's Contracture/Disease

1st Week:

You will go home from the hospital in a padded dressing which may contain a splint. This dressing will be worn until the first office visit after surgery.

Dupuytren After Surgery

Elevation of the hand and wrist is very important. For most of the week, you should try to keep your hand between the ceiling and your heart, regardless of the position you are in. For sleeping, the arm may be placed on a pillow over the chest, or on pillows out to your side, or you can sleep rolled up on the other side with pillows in front of you. When sitting, try to keep the hand elevated on pillows. When walking, also try to keep the hand up above the heart. We do not use slings because it is very difficult to keep the hand elevated in a sling, and it is important to keep your shoulder and elbow moving.

Ice applied over the operated area may help in the first 3 to 4 days. The ice should be kept in a plastic bag or cool pack in order to keep the dressing dry. It can be used intermittently. Not all the cold gets through because of the bulk of the dressing, but some gets through.

If some of your fingers or thumb are left free, it is good to move them occasionally. Try to straighten any free fingers as much as possible, and then bend them as much as the dressing allows. This should be done on a frequent, but not repetitive basis. The distance that the fingers move is what is most important.

Light lifting with the arm that has been operated on is acceptable.

Pain medication should be taken as needed. In general, pain medicines are needed the first 3 to 5 days, on a gradually decreasing basis. If you are able to take anti-inflammatory medicines such as Advil, they can be used in between the pain medicines. Anti-inflammatory medicines should not be used by patients with asthma, on blood thinners, or with ulcers. They should be taken with food, and stopped if stomach problems occur.

The dressing should be kept in place, as well as clean and dry. For showering, some type of plastic bag can be wrapped around the dressing. Options include garbage bags, bread bags, hunters dress gloves or vet gloves.

If you have problems or questions after this surgery, please call the Cedar Valley Hand Surgery office, 319-364-2697. Whenever possible, please call during normal office hours.

1st Post Surgery Appointment
The dressing will be changed on your first visit to the office after surgery, and the incision inspected. In most cases, you will be immediately referred to occupational therapy where a plastic splint will be custom made for you. The therapist will teach you how to remove the splint, change your dressing, and reapply the splint. You will be able to remove the splint for showering, and 3 additional times each day for range of motion exercises of the wrist and digits, including those digits operated on. The exercises are done slowly and gently, emphasizing as much range as possible. The therapist will give detailed instructions in these exercises.

Elevation may still be very important at this point, especially if the fingers and hand remain swollen. Most patients do not require pain medications at this point, although Tylenol or Advil may be needed occasionally.

The splint and dressing can be removed for showering this week. It is acceptable for soap and water to run over the incision with sutures still in place. The incision should not be placed under water, such as in dishwater, bath water, swimming, or hot tubs.

2nd Post Surgery Visit
At the second postoperative visit, usually 2 weeks after surgery, sutures are usually removed. Occasionally, some sutures will be left in longer.

The splint is worn except for bathing and except for exercises. More use of the operated hand and arm is possible, with the splint protecting the surgery.

3 days after the final sutures are removed, the incision can be submerged under water – such as bath water The incision scars from surgery should be massaged with lotion twice a day for three to 5 minutes, during one of the periods that the splint is removed. This lotion massage does several things, including breaking up scar tissue and retraining nerve endings.

3rd Post Surgery Visit
At this point, the splint is not needed during the day, but is still worn for sleeping.

Activities with the operated hand can be gradually increased. Pain and swelling are guides for this. If your activities are causing increasing pain and/or swelling, those are signs to back off on activities.

Exercises remain crucial to regain range of motion. These should be done 3 times a day. Using modalities such as heat and ice, in conjunction with the exercises and as taught by your therapist, may help significantly.

The key to exercises is regaining full distance of the arc of motion. Exercises should be done gently, not forcefully. The distance your fingers move is what is important, not how often or how fast the exercises are done.

Nighttime splint wear is continued for several months, with the exact time dependent on your individual situation. On occasions, different types of splints may also be required before or after surgery, and these instructions will need to be tailored to accommodate those additional interventions.