Following operative release for Dupuytren's contracture it is not uncommon to experience; swelling, scars, stiffness and some pain in the operated hand.
Most surgical techniques for Dupuytren's Disease involve many precise surgical incisions to remove the diseased tissues. With this amount of work in the palm and fingers, it is not surprising the hand can be uncomfortable to move and use afterwards.
To get the best results from your operation, following these simple steps should help;
For the first 10-14 days following the operation most people will have stitches holding their skin together. Disrupting wounds early can result in infection, excess scaring and skin breakdown.
During this time, unless advised by your surgeon or hand therapist, it is best to keep your hand rested and dressings clean and dry.
For the swelling
To help bring down the swelling, try elevating your operated hand. It may also help to gently raising your heart rate (walking around the room lifting knees up) whilst raising your arm.
Your hand therapist may recommend a gentle form of pressure over the hand and fingers to help manage swelling, for example a lycra glove or compression bandage.
For some people, medications and the operative technique may direct how swelling is to be managed, it's best to ask your surgeon whether you have any special precautions.
Safe early movement under the direction and observation of the hand surgeon or therapist can help prevent finger joint stiffness. In the early stages try to regain bending and straightening with your own muscle power. Depending upon your operation, using your other hand to straighten the operated or adjacent fingers or thumb may not be advised.
Gentle night extension splinting can be used to help stretch out any tightness in the joints.
Once the wounds are dry and clean and the skin is held together, scar massage can start. Keeping the scars in the palm of the hand and fingers supple is essential to getting the best bending and straightening. Early gentle massage with oily cream over the scars and surrounding skin is often combined with the use of a custom made extension night splint. Your hand therapist may also recommend a compression glove and special silicon gel products to help flatten and smooth the scar.
Using the hand
Depending upon the climate where you live, your work and hobbies, there may be some activities that are best avoided for the first month to 6 weeks. An experienced hand therapist will be able to discuss with you your individual goals, and make suggestions to help get you back to your valued activities as safely and quickly as possible.
Please note; if you experience excessive pain or swelling, stiffness or numbness it is always advisable to seek prompt assessment from your surgeon or treating doctor. A small percent of clients will experience complications following operative management for Dupuytren's contracture. Any complication following hand surgery is best diagnosed quickly.
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It is important that any lump or bump in your hand or arm is investigated by your doctor.
Commonly, however a lump in the palm of the hand is nothing to be concerned about.
A lump in the palm can be the first symptom that people notice of Dupuytren's Disease. Dupuytren's Disease is not dangerous, but it can make using the hand difficult as the disease progresses.
Dupuytren's Disease is a condition where thick tissues (fascia) under the skin on the palm contract over time. Initially a lump or nodule in the palm develops, people might feel this or see the skin over the lump puckering. It may be painful to hold onto the golf club, but otherwise non problematic.
This may be followed by difficulty straightening the finger (usually the little or ring finger or the thumb). This difficulty is caused by further contracting of the fascia and development of cords or bands into the fingers. These bands make straightening the finger increasingly difficult. People often say it becomes difficult getting something out of their pocket because the ring or little finger get stuck. Or they are embarrassed to shake hands as the fingers stay curled over.
The progression from lump in the palm to bent over fingers can occur rapidly or over several months or many years.
Dupuytren's disease is more common in men than women, and usually occurs in the sixth decade of life.
If you suspect you have Dupuytren's Disease, we recommend discussing your options with a Hand Surgeon. Hand Therapy can not help slow down the progression of the disease. We can, however, help you get the best outcomes following interventions from your Surgeon.
Call us 08 8339 HAND
Author Jo Marsh
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