Dupuytren's Release — Rehabilitation Protocol PDF ¶

Rehabilitation after Dupuytren's fasciectomy — the extension splint regime and exercise program, with hand-therapist follow-up.

This protocol guides your recovery after surgical release of Dupuytren's contracture (fasciectomy) with Dr Kieran Hirpara at Mater Private Hospital Rockhampton. The two pillars of a good result are the splint, which holds the freed fingers straight while everything heals, and the exercise program, which keeps them moving. Bring this page or its PDF to your hand therapist so your rehabilitation stays coordinated.

If you have any concerns about your wound after surgery, get in touch with the rooms. It is often helpful to take a photo of the wound and email it for review.

What to expect¶

Surgery for Dupuytren's disease removes the diseased cords of tissue that were pulling your fingers into the palm, restoring the ability to straighten them. The condition itself is explained on the Dupuytren's disease page; there is no permanent cure, and the goal of surgery is to excise the diseased tissue and restore finger extension.

You will usually be referred to a hand therapist 2–3 days after surgery. The therapist will make you a custom plastic splint that holds the operated fingers in an extended (straight) position, and will start you on the gentle exercise program below. The splint and the exercises work together: the splint defends the straightness the surgery won, and the exercises keep the fingers bending so they don't stiffen.

Keep the wound clean and dry until your sutures are removed. Once the sutures are out you can get the skin wet, but avoid soaking or submerging the hand in water for another week. The practice's wound care page covers dressings, signs of infection and scar care in detail — scar massage matters after Dupuytren's surgery, and your therapist will guide it once the wound has healed.

Caring for your scar¶

The scar in the palm is often firm, raised and tender for the first weeks after Dupuytren's surgery before it gradually softens and fades over the following months. Scar massage is a routine part of Australian hand-therapy care: in a national survey of accredited hand therapists, almost all used it after hand surgery — typically starting around suture removal, once the wound has fully healed — to soften the scar, improve how the skin glides over the tissues beneath, and settle scar sensitivity, usually combined with silicone gel or sheeting rather than used on its own [6]. The research evidence behind scar massage is still developing, but it supports its use for reducing scar-related discomfort and improving movement [6]. Your therapist will show you the technique and may add a silicone product, often worn at night alongside the splint.

Recovery, work and the long term¶

Swelling and stiffness are normal in the early weeks and settle as the hand is used; comfort, motion and grip generally keep improving over several months. The straightness gained at surgery is usually well maintained through this period — in a randomised trial of rehabilitation after Dupuytren's release, most operated fingers held or improved their extension over the first three months of hand therapy [2].

Time off work depends on what you do with your hands. In a study of more than 2,500 people treated for Dupuytren's disease, the median return to work after open fasciectomy was about two weeks, and around nine in ten people were back at work within the year; physically demanding jobs took longer [4]. Dr Hirpara will discuss timing for your particular work at review — heavier manual work usually waits until the wound is soundly healed and grip is comfortable.

Because Dupuytren's is a lifelong condition, some tightness can return over the years, and reported recurrence rates vary widely between studies depending on how recurrence is defined. The long-term picture is generally reassuring: in a follow-up of 142 fasciectomies over roughly four years using the modern consensus definition, true recurrence of contracture occurred in around 3–4% of hands, although about a third kept some residual curvature — usually mild and well short of the contracture corrected at surgery [5]. The splint, scar care and exercise program are all aimed at protecting your result; if a finger does begin to tighten again at any point, let the rooms know.

Your splint¶

First week or so: wear the splint day and night, removing it only for your exercises (and washing, once permitted).
After the first week: most people move to night-only splint wear, and can begin using the hand for light activity during the day.
Night splinting continues for about 3 months — and in some cases up to 6 months — to protect against the fingers drifting back toward the palm while the tissues mature.
Your hand therapist and Dr Hirpara will advise you specifically about your splint-wear schedule and activity — the timings above are the usual pattern, not a fixed rule.

You must not drive while your hand is in the splint. Once you move to night-only wear, daytime driving can resume as comfort and a safe grip on the wheel allow.

For your physiotherapist / hand therapist:

Management

Referral 2–3 days post-operatively for fabrication of a thermoplastic extension splint
Splint regime: day and night for approximately the first week (off for exercises), then night-only with light functional day use; night splinting continued for approximately 3 months (up to 6 months where needed), per surgeon/therapist review
Home exercise program as per the cards below: active extension, blocked DIP flexion, DIP/PIP flexion over a pen, composite flexion, wrist tenodesis
Wound care per the practice's wound care guidance; scar management once healed
Repetitions and daily frequency set by the treating therapist

Precautions

Keep the wound clean and dry until suture removal; no soaking/submersion for a further week after
Splint compliance is central to maintaining the extension gained at surgery
No driving while the hand is in the splint

These are the exercises from your handout, started with your hand therapist and continued at home.

Your exercises¶

Active extension

With your wrist straight, straighten and spread your fingers as far as you can. You may assist gently with your other hand. Relax and repeat.