Information and advice following Dupuytren’s surgery

This leaflet is designed to give general advice and information about the condition of Dupuytren’s disease, expected recovery times, hand therapy advice and exercises following surgery.

What is Dupuytren’s disease?

Dupuytren’s disease (also sometimes called Dupuytren’s contracture) is a harmless and usually pain free condition that affects the hand. It is caused by a thickening of deep tissue (fascia) within the palm and fingers. This thickening leads to firm nodules and cords developing which pull the fingers down towards the palm and prevent them from straightening fully. It then can become difficult to use the hand in normal day-to-day tasks.

Treatment of Dupuytren’s disease

A large number of people live with Dupuytren’s disease in the hand with no significant functional difficulties. However, when the finger(s) start to curl, patients can report difficulties in wearing gloves, shaking hands, getting the digit caught when placing hand into the pocket or washing the face.

Unfortunately, there is no cure for Dupuytren’s contracture. Although surgery aims to improve the straightness of the affected fingers, there are no guarantees. Dupuytren’s also has a high rate of recurrence, and may reappear following surgery- either to the operated site, or elsewhere in the hand.

Surgery is usually carried out when the contractures have become severe enough to prevent the patient placing the hand flat on a table top, or where the disease progression has been rapid.

What will my surgery involve?

1. Needle fasciotomy - a small blade or needle is used to divide the cord(s). Not suitable for established contractures.
2. Fasciectomy - the finger is straightened by removal of the diseased fascia through a zig-zag surgical cut or incision.
3. Dermofasciectomy - both the diseased fascia and the overlying skin are removed. A skin graft (usually taken from the arm) will replace the removed skin.

What does Hand Therapy involve after Dupuytren’s surgery?

While surgery aims to improve the straightness, or extension of the affected finger(s), Hand Therapy aims to maximise the surgical gains and regain functional use of the hand. The more contracted (bent) your finger was prior to surgery, the more difficult it is to predict the outcome.

The amount of therapy required will depend on how difficult you find bending the fingers and regaining normal hand use. In the early stages of your recovery you may require regular input from your therapist, but as you heal and your finger movement improves, therapy input can be reduced. To maximise your recovery it is important to comply with therapist’s advice.

For some patients, a moulded thermoplastic splint is required to maximise the straightness of the finger(s). Your therapist will make this splint for you if required. The splint can be worn for up to 12 months at night-time only as it is important to use the hand normally during the day.

Exercises following surgery

It is important to start to exercise or move your fingers early on following surgery as this will speed up your recovery and allow you to use the hand normally sooner. This leaflet will teach you appropriate exercises to maximise your recovery.

Following surgery it is very likely that your fingers might be stiff and swollen. Exercises can be very beneficial to improve your movement and allow you to use your hand normally.

The following exercises will help to reduce stiffness and increase finger movement. When completing the following exercises you may experience tightness or a pulling sensation, this is normal. If you experience a sharp pain, reduce the intensity of the exercises or stop for a couple of days to allow the pain to stop.

Sit comfortably with your elbow on a table surface and your hand in the air.

Active finger exercises

With your unaffected hand hold and stabilise the injured or stiff finger at the middle joint, this will block the middle joint from bending. Allow the movement to occur at the fingertip only. Bend and straighten the tip of the finger.

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With your unaffected hand hold and stabilise the injured or stiff finger at the large knuckle. Bend and straighten the middle joint of the finger, if the top joint bends, don’t worry, this is normal.

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Start with your fingers straight, bend at the large knuckles keeping the top joints of your fingers as straight as you can, hold for the count of 5, then straighten your fingers.

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Keeping the large knuckles and wrist straight, bend and straighten the top and middle joints of the fingers. Complete this slowly, holding the bend for a count of 5 seconds.

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Make a fist, being sure each joint bends as much as possible, hold the fist for the count of 5, then gently open your fingers to straighten them.

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Spread fingers wide apart and bring then together. Complete this exercise slowly holding your fingers apart for the count of 5 seconds then close together.

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With your palm facing towards you, keep your big knuckles bent and place your other hand on top while you straighten out the middle and top joints of the fingers as straight as you can.

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Passive finger exercises

Supporting the operated hand gently push each finger so that your finger is as straight as you can achieve.

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Using your unaffected hand to assist in bending the finger, start by individually curling your finger towards the palm. Take each finger in turn, aiming to improve finger bend.

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Place your hand onto a table or flat surface. Hold the finger, ensuring that the middle joint does not bed, then with your other hand, curl the tip of your finger to the palm.

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Start by holding the middle joint of your affected finger slightly bent with your other hand.

Keeping the middle joint bent, apply pressure to stretch the end joint as straight as you can. Push until you feel a stretch but not severe pain.

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What will be my recovery timeframe following surgery?

Wound healing can take 2-3 weeks depending upon the type of surgery you have had. If you required a skin graft then healing can take slightly longer as the graft is protected for the first 7-14 days. Once the graft has taken, therapy can begin.

Most patients start to use their hands normally at around 10-21 days after surgery, once the sutures have come out and the wound has healed. At this stage scar management and increasing your exercises and functional use is a good idea. Your therapist can advise you on this.

When can I drive?

This can depend on the severity of the contracture and the extent of operation.

Typically individuals return to driving approximately 2 weeks post-surgery, usually when the wound is healed, sutures removed and you can confidently and safely hold a steering wheel.

When can I wash the hand?

You can begin to wash the hand once the wound is fully closed or healed. Initially it is advisable to wash it under running water rather than soaking it in water to avoid the risk of infection.

When can I return to work?

Returning to work will depend on the demands of your profession and the healing of your hand. In general, light manual jobs (e.g. office work) can usually be resumed within 1-3 weeks, while heavier more manual work may be resumed at 4-8 weeks. It is advisable to return to light duties initially.

Care of your scar

Scars are collagen fibres produced as a result of the body’s normal healing process. The amount of scar tissue produced by the body varies depending on the individual and type of surgery/ injury.

Why is it important to care for your scar?

Initially scars can be firm, thick and red in colour (active phase) but over time soften and become pale in colour (matured). This whole process may take 12 to 18 months or more.

During the “active phase” you can use treatments to influence your scar. Initially as scar tissue forms it is firm and tacky and can stick to structures around it; scar care helps to flatten, make it softer and reduces the chance of scar tissue sticking (adhesions). Scar massage can be one of the most effect treatments to reduce scar tissue build up. The following section explains the technique.

Manual scar massage

When can I start?

24-48hrs after your stitches have been removed, if the wound is dry.

If you have dissolvable stitches you start massaging your scar at approximately 12-14 days after your surgery, providing the wound is healed and dry.

What do I need?

You will need a basic, un-perfumed moisturising cream. For example aqueous cream or ‘E45 cream’ are ideal for massaging the scars.

Method

The scar massage needs to be in circular movements, on and around the scar line, to keep the skin moving freely. In the first few days you may only tolerate gentle massage but you should then aim to increase it to a deep and firm massage to reduce the risk of adhesions (see picture below).

Your therapist will advise you as to how long you should continue with your massage.

Start date………………………………..

Repeat ………..times per day for approximately……….minutes, ideally before your exercises.

Possible complications following surgery

Wound infection

If you suspect an infection it is important to contact your GP straight away. Signs of infection might include:

• Redness
• An increase in swelling
• A change in pain
• Discoloured discharge from a wound

You may require antibiotics to treat the infection.

Swelling

It is normal to have some swelling present after surgery. This may remain in the hand or fingers for weeks to months. Swelling can change throughout the day. It is important to discuss concerns with your therapist, who will be able to advise you about the best course of action.

Numbness or reduced sensation

Removal of the diseased tissues in Dupuytren’s often requires delicate work around the nerves in the fingers. It is common to have temporary loss of nerve function. Some numbness is common and may last for weeks to months. It is best to discuss any concerns with your therapist or consultant.

Pain

It is normal to experience some pain post surgery. Each individual’s experience of pain is very different. The use of ibuprofen and paracetamol, as per the manufacturer’s instructions, can aid management of pain. If your whole hand is very painful and swollen post-surgery, it is advisable to contact your G.P. Therapist or consultant for advice.

Contacts/further Information

The Occupational therapy department is located in clinic 30 in the Addenbrooke’s Treatment Centre (ATC). The Occupational therapy reception telephone number: 01223 216769

References/sources of Evidence

• Brandt (2010) An evidence-based approach to Dupuytren’s contracture. Plastic and Reconstruction Surgery.126(6), p2210-2215.
• Eaton (2014) Evidence-based medicine: Dupuytren contracture. Plastic and Reconstruction Surgery, p133- 142.
• Jerosch-Herold et al (2011) Night time splinting after fasciectomy or demofasciectomy for Dupuytren’s contracture: A pragmatic, multi-centre, randomised controlled trail. BMC Musculoskeletal Disorder. 21(12), p136-148.
• Karam et al (2022) Comparison of Hand Therapy with or without splinting post fasciectomy for Dupuytren’s contracture: Systematic review and meta-analysis, Journal of Hand & Micro Surgery, 14(4), p308-314.
• Larsen & Jerosch-Herold (2008) Clinical effectiveness of post-operative splinting after surgical release of Dupuytren’s contracture: a systematic review, BMC Musculoskeletal Disorders, 9(104).
• Townley et al (2006) Dupuytren’s contracture unfolded, BMJ, 332, p397-400.
• Wilburn et al (2013) The impact of Dupuytren’s disease on patient activity and quality of life. Journal of American Hand Surgery, 38(6), p1209-1214.