Dupuytren's contracture

Dupuytren's contracture

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Discussion

PositronicRay

Original Poster:

26,957 posts

182 months

Thursday 11th August 2022
quotequote all
I've suffered with this for ages, 15yrs ago i had a partially successful op on one finger. Since then just decided to live with it.

Starting to get painful now, particularly if I'm doing heavy work with my hands, so I've booked an appointment to start the ball rolling again.

Does anyone know if treatment has improved, happy to go privately if need be.

Nico Adie

610 posts

42 months

Thursday 11th August 2022
quotequote all
Triamcinolone injections for Dupuytren's have shown to be pretty effective, more so than a needle fasciotomy. Would be worth enquiring with private providers if you have the money. The next "step up" from that would be a Fasciectomy (almost certainly under a GA), and further still a Dermofasciectomy (again, almost certainly and even more likely to be under GA). It'll obviously depend on how advanced/severe your condition is WRT the course of treatment. I've been lucky enough to observe all of these procedures in theatre. Also, don't forget the post-op physio exercises!

Here's a wonderful site full of images of the various procedures pre, peri and post-op:

https://eatonhand.com/img/img00000.htm

I am not a doctor, but I co-ordinated a huge research study into Dupuytren's about 10 years ago, got a bottle of Dom Perignon for my troubles. Which was nice.

PositronicRay

Original Poster:

26,957 posts

182 months

Thursday 11th August 2022
quotequote all
Nico Adie said:
Triamcinolone injections for Dupuytren's have shown to be pretty effective, more so than a needle fasciotomy. Would be worth enquiring with private providers if you have the money. The next "step up" from that would be a Fasciectomy (almost certainly under a GA), and further still a Dermofasciectomy (again, almost certainly and even more likely to be under GA). It'll obviously depend on how advanced/severe your condition is WRT the course of treatment. I've been lucky enough to observe all of these procedures in theatre. Also, don't forget the post-op physio exercises!

Here's a wonderful site full of images of the various procedures pre, peri and post-op:

https://eatonhand.com/img/img00000.htm

I am not a doctor, but I co-ordinated a huge research study into Dupuytren's about 10 years ago, got a bottle of Dom Perignon for my troubles. Which was nice.
Oh thanks, i had a partially successful procedure 15yrs ago. It involved an injection, some time for it to dissolve the crystals then (under local) a vigorous manipulation of the digit. Strange to feel the crack as the tendon released.

Sounds like things have moved on a bit.

elanfan

5,516 posts

226 months

Thursday 11th August 2022
quotequote all
If I may hijack the thread a little? I think I have the start of this. On the left hand I have a a small ball about 6mm prod 2cm down from the third finger. On the right palm I have 3 smaller lumps, 2 either side of the bone to the third finger and one between index and middle finger - all approx 2 cm from the finger joint. I’d say all are marginally bigger than they were a year or so ago. Not painful, no obvious contracture and I I can stretch my fingers without issue.

What I want to ask as I’m likely to develop issues in future is, is there a benefit in getting these treated early to avoid future problems?

Thanks and sorry again for the hijack (though will hopefully help others).

PositronicRay

Original Poster:

26,957 posts

182 months

Thursday 11th August 2022
quotequote all
I think the NHS will want to wait untill its much more advanced.

Worth having a consultation anyway.

Moz

34 posts

249 months

Thursday 11th August 2022
quotequote all
I'm 49 and have had 7 surgeries, including 3 skin grafts and a partial amputation.

It's my experience that you absolutely must go private. I've had so many hash jobs on the NHS that it impacted future surgical options.

Look up Donald Sammut. His care has been first class and he's cheaper than I expected.

PositronicRay

Original Poster:

26,957 posts

182 months

Thursday 11th August 2022
quotequote all
Moz said:
I'm 49 and have had 7 surgeries, including 3 skin grafts and a partial amputation.

It's my experience that you absolutely must go private. I've had so many hash jobs on the NHS that it impacted future surgical options.

Look up Donald Sammut. His care has been first class and he's cheaper than I expected.
Thank you, a useful link. A bit of googling indicates £3-4k, I'm assuming per digit.

Edited by PositronicRay on Thursday 11th August 16:26

gazza285

9,780 posts

207 months

Thursday 11th August 2022
quotequote all
PositronicRay said:
I think the NHS will want to wait untill its much more advanced.

Worth having a consultation anyway.
The NHS told me to come back when the fingers were 60° from straight, then they would consider operating.

Moz

34 posts

249 months

Thursday 11th August 2022
quotequote all
Positronic - I think the pricing is based on the expected duration of the surgery rather than on a per digit basis.

NorthDave

2,355 posts

231 months

Friday 12th August 2022
quotequote all
There is a product available in the US which they inject in to the tendon and it breaks down the lumps. It was available on the NHS for a short time but seems to have been removed - possibly due to cost.

Just googled and it is called Xiaflex. Not sure if it is available privately or just in the US but seems easier than surgery.

pavarotti1980

4,837 posts

83 months

Friday 12th August 2022
quotequote all
Moz said:
I'm 49 and have had 7 surgeries, including 3 skin grafts and a partial amputation.

It's my experience that you absolutely must go private. I've had so many hash jobs on the NHS that it impacted future surgical options.

Look up Donald Sammut. His care has been first class and he's cheaper than I expected.
Donald Sammut is an NHS consultant. You private care is done by the same surgeon as if you went to through the NHS

Private care does not get a superior surgeon, just jump the queue for treatment

PositronicRay

Original Poster:

26,957 posts

182 months

Friday 12th August 2022
quotequote all
NorthDave said:
There is a product available in the US which they inject in to the tendon and it breaks down the lumps. It was available on the NHS for a short time but seems to have been removed - possibly due to cost.

Just googled and it is called Xiaflex. Not sure if it is available privately or just in the US but seems easier than surgery.
I think i had this or something very similar 11 yrs ago, funded by BUPA. It was only partially successful.

PositronicRay

Original Poster:

26,957 posts

182 months

Friday 12th August 2022
quotequote all
pavarotti1980 said:
Moz said:
I'm 49 and have had 7 surgeries, including 3 skin grafts and a partial amputation.

It's my experience that you absolutely must go private. I've had so many hash jobs on the NHS that it impacted future surgical options.

Look up Donald Sammut. His care has been first class and he's cheaper than I expected.
Donald Sammut is an NHS consultant. You private care is done by the same surgeon as if you went to through the NHS

Private care does not get a superior surgeon, just jump the queue for treatment
Probably true, but the NHS doesn't allow you to specify consultants out of area.

pavarotti1980

4,837 posts

83 months

Friday 12th August 2022
quotequote all
PositronicRay said:
Probably true, but the NHS doesn't allow you to specify consultants out of area.
You can ask to be referred anywhere in reality. The CCG making the referral will be paying the same tariff cost regardless of geographical location. They will discourage it but you can insist

gazza285

9,780 posts

207 months

Friday 12th August 2022
quotequote all
PositronicRay said:
I think i had this or something very similar 11 yrs ago, funded by BUPA. It was only partially successful.
It works by dissolving the collagen buildup around the tendons, there’s currently no cure to stop it returning.

Regbuser

3,319 posts

34 months

Friday 12th August 2022
quotequote all
Prescient, have just been for a consult for my now worsening right hand at the Pulvertaft, Derby.
Previous thread here > https://www.pistonheads.com/gassing/topic.asp?h=0&...

Fingers today, they said too far gone for a needle aponeurotomy, so it's a trip to the surgeons in 12 weeks.


PositronicRay

Original Poster:

26,957 posts

182 months

Friday 12th August 2022
quotequote all
Regbuser said:
Prescient, have just been for a consult for my now worsening right hand at the Pulvertaft, Derby.
Previous thread here > https://www.pistonheads.com/gassing/topic.asp?h=0&...

Fingers today, they said too far gone for a needle aponeurotomy, so it's a trip to the surgeons in 12 weeks.

Mine looks similar. Damn it'll put me out of action for a few weeks (at least)


Regbuser

3,319 posts

34 months

Friday 12th August 2022
quotequote all
Don't know if you're in the Midlands, but Pulvertaft are a centre of excellence; they'll sort it properly.
After previous surgery, it was a bit sore and weepy for a week, but I just got into the wound cleaning and dressing, and I was driving the next week no probs. Colloidal and silver dressings are wonderful devices!

PositronicRay

Original Poster:

26,957 posts

182 months

Friday 12th August 2022
quotequote all
South warks.

Recovery time is a pain, wife can drive for bit, but it'll curtail other activities.

Regbuser

3,319 posts

34 months

Friday 12th August 2022
quotequote all
It is what it is - no regrets from left hand op, 3yrs on and good.