On April 17, 2009, Dr. David Nelson performed a Dupuytren's Contracture surgery on my right hand, involving the little finger and palm. Everything went off like clockwork at the surgery center. I did not need a splint and experienced very little pain, choosing to not take the prescribed pain medication after the anesthetic wore off. According to notes I kept, on the sixth day there was some swelling, redness and tenderness but it did not keep me from making a trip away from home. The exercises I'd been given were easy to follow and my only restriction was to avoid getting hot water on the wound, so I used a plastic bag and rubber band around my wrist when showering.
I began physical therapy at the Hand Clinic on the 4th day after surgery and continued there for about 8 weeks, following the exercises prescribed. The clinic staff were excellent and I progressed very rapidly. By the end of the second week, I was able to fully work in my garden and do other chores with only an elastic "glove" over the affected area to keep it clean. At this point, 6 months after surgery, I am very pleased to have the full use of my right hand, with the affected area completely back to normal, only minimal scarring and full extension of the little finger.
October 19, 2009
Duputytren's Release in 65 Year Old Retired Executive
I am recently retired and I enjoy golfing. I have been effected in both hands by Dupuytren's for almost 20 years. Earlier this year I had surgery on one hand. I never suffered any pain, and six weeks after the surgery I went to a driving range and could hit golf balls. A couple of weeks later, my wife and I went to Scottsdale, AZ, for about a month and played golf about eight times. And though my game was not a whole lot better, it was not any worse either. I have completely recovered from the surgery and am glad I had it. I plan to have surgery on the other hand soon."
Duputytren's Release in 64 Year Old
My name is Ellis Jones. I am 64 years old. I had Dupuytrens surgery by Dr. Nelson on December 14,2007. I am writing this on February 29, 2008. Therefore, I am about 2.5 months past surgery. I am writing to provide information on my experience to future patients.
My experience is in the context of prior surgeries. I had a radical prostatectomy in 1998, a major surgery with several days in the hospital and two weeks with an internal urinary catheter after that. Subsequently, over the next five or six years, I had four out-patiient surgeries. I had inguinal hernias repaired on both sides. Later I had arthroscopic surgery on both knees. All five of these surgeries were quite successful, and all of my recoveries have been without great difficulties. Nevertheless, I hate surgery., I hate needles, IVs, anesthesia, hospitals, having my body invaded, etc., etc.I decided to go through surgery with Dr. Nelson because my hand was beginning not to work for me as well as I wanted it to. My right ring finger was still straight but pulled forward to the extent that I couldn’t flatten my palm. The last joint of that finger was painful, because it was always hitting things first or taking much more pressure than the joints on the other fingers of my right hand. Once before I had begun to schedule Dupuytrens surgery, but my hand just hadn’t gotten bad enough to overcome my aversion to surgery.
Dr. Nelson’s explanation of how surgery would go and how his pain management regimen would work were entirely borne out. Marin General’s surgery staff were very kind and supportive. I became rather faint when my IV was put in which is predictable for me. I had warned my nurse who took good care of me while the faintness passed. After surgery the combination of Celebrex and Tylenol worked well. I never felt pain and never used any Vicodin.
Recovery from Dupuytrens surgery was, however, more difficult than my prior outpatient surgeries. First, the hernia and knee surgeries left very small incisions, whereas the Dupuytrens surgery left a big zig-zag incision on my right hand that required significant protection and care. It increased my sense of having my body invaded, which is a sense I’ve had before. It may be more powerful for me than for other people. I’ve spent most of my life in a state of exceptional health. The last decade of surgeries (and mild cancer treatments) has been a change in my life that I wouldn’t have chosen (even though it has increased my appreciation of day-to-day life). The incision has healed quite well at this point.
Second, I didn’t perceive ahead of time how crucial to my recovery physical therapy would be. Dr. Nelson had told me that I would be doing more physical therapy than I would think necessary, but I didn’t know what that meant. I want to emphasize that my experience at Hand and Physical Therapy of Marin was excellent. I really liked my therapist and everyone else there, and my hand improved in record time (I’m told) to the extent that I was discharged from therapy last week.
Hand Therapy after a Dupuytrens release is designed, as I understand it, to prevent scar tissue forming in response to surgery, to prevent recontracting one’s hand, and to prevent grabbbing (scarring) onto the tendons, and to keep the tendons sliding freely. My hand was not painful when not in use, but sore when going through my stretching and clenching exercises. The soreness would remain afterward for a while. My therapist made me a custom splint to be worn most of the time at first and later just at night. The splint was comfortable, but my hand would be very stiff in the morning and sore when I tried to do my clenching exercises.
My hand stayed sensitive for long enough that I wondered how long this was all going to take, even though I made steady progress. About 2 weeks ago I became able to use my hand more or less normally without thinking about it very much. I still couldn’t use a hammer for very long. Especially the heel of my hand is still sensitive. I couldn’t drive for more than a couple of hours a day without getting a sore hand. I still need to do my exercises to keep my hand flexible. I still have some tingling in my middle finger. My hand, though, is pretty good overall. I’m glad I had the surgery. I expect my hand to improve to the point of full recovery within the next several months. I will see Dr. Nelson again only if I have questions or problems.
Duputytren's Release in Three Fingers of a 74 Year Old
George at the first followup visit at 10 days
At age 74, my little finger, the fourth finger and the middle finger of my right hand were significantly constricted from a normal fully open possition. I am right handed and an active person, so it was time to fix the fingers. Dr Nelson has an excellent web site as well as an open, informative way of relating. The surgery went well.
I managed the mild postoperative pain with the mild medications recommended. Nine days after surgery I was able to safely drive. My fingers all open fully again, and the remainder of physical therapy will be easy. I can now shower and even do careful lifting. I am typing this letter with the right hand! I recommend David Nelson to anyone who is ready to have surgery for Dupuytren's contractures of the fingers. Something disturbing did happen after surgery that disturbed me, only because I did not know what to expect. Dr. Nelson has asked me to talk about it here, and he has made clear that the oversight is already corrected in his preoperative information:
Preoperatively, it was made clear to me that in order to allow safe, light anaesthesia, that there
Closeup of George's hand at 10 days (Note that all of the
sutures are inside the hand, and you cannot see them.
They dissolve by themselves.
would be a catheter inserted into the arm for full anaesthesia during the procedure. When I regained consciousness, my arm was floppy, I had no motor control of it. Although reassured by the anesthesiologist and Dr. Nelson, I was suprised by the floppiness, and frankly, I was shaken. As is the normal process, I was sent home with the information that the catheter would be removed the next morning. I awoke at 4:30, still with a numb arm with no motor control.
We called Dr. Nelson at once (Note: he really did wake me up at 4:30 am! It was my birthday, so I just considered it my first Birthday Call of the day - Dr. Nelson) and he answered at once. He told me that the arm was floppy because it was still getting the anesthetic from the pump attached to the catheter. At my request, he directed my wife to remove the catheter. Three hours later I had full control of my arm again. Had I been told to expect that this could normally happen preoperatively, the fear would not have happened.
George C. Wilson Jr., M.D.
Duputytren's Release in a Musician
I had been developing Dupuytren's Contracture for about 5 years, and decided to proceed with surgery on my right hand after consulting with Dr. Nelson. I'm a classical guitarist, so I was concerned about my hand's sensitivity, control, dexterity, flexibility, and strength. The Dupuytren's was starting to interfere with my ability to stretch my hand out fully, and it seemed to make it harder to accurately place my fingers on the correct strings and pluck them in just the right way; I was making more and more mistakes.
Two weeks after surgery, and after several delightful sessions at The Hand & Physical Therapy Center of Marin, I was delighted when Dr. Nelson told me I could start playing music again, gently at first and for about 15 minutes. There was no pain, and I gradually increased my playing strength and speed over the next 2 weeks, until I could play an hour at a time with no problem. I have performed in public several times over the last 6 weeks. I actually think I play better now than before!
I also practice yoga. Another benefit of the surgery is that after 8 weeks, I can now do the "downward dog" position, requiring the hand to be flat on the floor or mat, bearing the weight of the body above it.
I also mountain bike and started doing that again after 4 weeks, with only a slight bit of discomfort from handling the brake levers; after 8 weeks, it's back to normal, and I just did a "full moon ride" with friends last night!
Dr. Nelson's pain management recommendations worked very well for me. I took only Tylenol for only two days after surgery, and nothing after that.
I plan to have the same procedure done on my left hand later this year, and I am confident it will go as well or better than my first experience.
Thank you, Dr. Nelson, for all your dedication, patience, and hard work.
Classical Guitarist, Lute Player, Composer
Duputytren's Release with No Post-op Pain
I have been very pleased about my Dupuytren's surgery. Dr. Nelson's approach in communicating, evaluating, and diagnosing the problem in layman's terms was a real plus (I could even explain it to my wife!). Of particular interest to me, and I suppose to most people facing surgery, was the study on pain management, conducted at Marin General Hospital and approved by the Investigation Review Committee. In my case, the pain management program worked perfectly (I realize, of course, it is not the same for everyhone having this surgery). I experienced no post-operative pain, and ceased taking the anti-inflammatory and Tylenol after the third day, and never resumed as it has not been necessary. No doubt, the numbing shots before and after the surgery played a key part.
Setting up a hand therapy appointment with Hand Therapy of Marin has turned out to be very helpful in the healing process and regaining hand strength. Again, in my case, my hand has healed without complications. After approximately 6 weeks, I am about 90% back to normal.
That's essentially my experience. I suspect most patients facing surgery have some anxiety and I was no exception. It went well and the post-operative peroid was well beyond expectations. I feel good that I can extend all my fingers and to feel that I had "hands on" professional care from start to finish.
P.S. (Name withheld by request)
Duputytren's Release with Three Fingers Released
No Post-op Pain
It has been ten days since my operation and I feel great. I had no pain from the procedure and although I had three seperate incisions to release my fingers, I never needed to use any pain medication. I feel that I was well prepared for the surgery (from talking to Dr Nelson and reading this site) and really can't think of anything that would have better prepared me. The therapists at The Hand & Physical Therapy Center of Marin are wonderful and do a great job of getting their patients back to normal.