After having hand surgery for Dupuytren’s contracture, you may need specialised hand therapy to improve the function of your hand. This should be discussed with your specialist before the surgery. The type of therapy you may need could include:
> physiotherapy, which can involve manipulation, massage, exercise, electrotherapy and hydrotherapy to improve your range of movement
> occupational therapy – if you are struggling with everyday tasks and activities, either at work or at home, an occupational therapist will give you practical support to make those tasks easier
How long your treatment lasts, and how often you have appointments, will depend on how extensive your surgery was.
For a fasciectomy, you may need hand therapy for up to six months.
After having surgery, your hand may be put in a splint. Initially, splinting may be recommended all day, before being used at night only. Gradually, it will not be used at all. Splinting usually involves bandaging your fingers to a plastic strip while they are in the straightest position that you find comfortable.
Currently, the use of splints is not a standard procedure. Some doctors prefer not to use them at all. When they are used, there is wide variation in the length of time they are used for, the position of your fingers, and how much force is used to keep your fingers straight.
Some doctors believe that splints can positively influence the way that scar tissue forms after surgery, so that the scar does not contract and cause the condition to return. Other doctors believe that splints cause unnecessary pain, joint stiffness and oedema (swelling), so they prefer not to use them.
Research into the use of splints is quite limited. A trial is currently underway to compare the effects of splints used after surgery with hand therapy, against the effects of just hand therapy alone. This will hopefully establish whether splints improve hand function, range of movement and the risk of Dupuytren’s contracture reoccurring.
Will the condition return?
Dupytren’s contracture can return to the same spot on the hand, or it may reappear somewhere else. Recurrence is more likely if you are younger, if your contracture was severe, or if you have a strong family history of the condition. The experience of the surgeon may also influence the chance of recurrence.
After a needle fasciotomy, the recurrence rate can be as high as 50%.
After a fasciectomy, this decreases to 35%.
For dermofasciectomy, the recurrence rate can be as low as 8%.
When can I start driving again?
You can start driving as soon as you feel confident enough to control the car safely. This is usually after about three weeks, but it may be longer if you have had a skin graft.
When can I go back to work and sport?
This depends on your job and on the type of operation that you have had. Someone who does heavy manual work may not be able to return to work for six weeks after having a skin graft. An office worker may be able to return to light duties a few days after having a fasciotomy. The same advice applies to sport.
If you are struggling to do everyday activities, hand therapy may help to improve the range of movement in your hand. Speak to you therapist (if you have one) or your GP if you think this may benefit you.
Can the condition be prevented?
As the cause of Dupuytren's contracture is unknown, it is difficult to prevent. If you are at risk of getting the condition – for example, if you have had it before, or you have a family history of it – reducing your alcohol intake and stopping smoking (if you smoke) may reduce your risk of developing it.