I had surgery for Dupuytren's disease two years ago. It worked okay. The hand therapist helped me afterwards to get my grip strength and motion back. Now I've got the problem in the other hand. The surgeon wants to do a less invasive operation this time. He will just nick the tight cords rather than cutting open my hand, etc. Will I even need therapy this time?
As you probably know, Dupuytren's disease is a condition where the tissue just under the skin in the palm of your hand becomes thick and shrinks, pulling very tight. In some cases, this causes lumping or unevenness of the palm of the hand and in others, it can cause a significant flexion contracture, making the hand look as if it is permanently holding on to something.
The regularly accepted treatment for Dupuytren's has been surgery. It sounds like you've already been down that path. A new treatment called percutaneous aponeurotomy has been developed and studied. Early results using this technique for Dupuytren's disease have been very promising.
Percutaneous means the procedure is performed through the skin without an open incision. After numbing the skin, the surgeon passes a small needle through the skin to the tight cords and makes several cuts. Cuts are made until the finger can be moved by the surgeon through its full range-of-motion.
The need for formal hand therapy is reportedly less following percutaneous aponeurotomy. The therapist may evaluate you, give you a home program to follow, and recheck you several weeks later. If you develop significant problems with motion, don't get your motion back, or have persistent weakness, then a formal rehab program may be needed.
Ramesh C. Srinivasan, MD, et al. New Treatment Options for Dupuytren's Surgery: Collagenase and Percutaneous Aponeurotomy. In The Journal of Hand Surgery. August 2010. Vol. 35-A. No. 8. Pp. 1362-1363.
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