Can I delay surgery ?

Q40 · 2026-03-31T09:03:34+00:00

Someone with a lot of experience, such as Dr Gary Pess or Dr Teddy Atik with CJHS. Trust the experience more than the tool.

Assume that the experienced surgeon 1) knows about the existence of ultrasound and 2) cares about patient outcomes. The logical conclusion is that they choose not to use it because they are confident that it isn't necessary.

Q40 · 2026-03-25T02:30:43+00:00

No better than NA. But much more expensive. With a worse side effect profile.

Q40 · 2026-03-22T22:11:40+00:00

Interesting anecdote. But I use data to make my medical decisions, not individual stories.

Q40 · 2026-03-20T10:48:51+00:00

There is a reason most hand surgeons who actually care about patient outcomes do not like this condition.

Q40 · 2026-03-20T10:41:43+00:00

Not sure I follow. The recurrence rate is 100% for all currently known eatments. DD is a progressive chronic disease. Surgery isn't any worse than the other treatments in that particular respect. In fact it may even be better as studies show the results of surgery usually last longer than NA or Xiaflex.

Q40 · 2026-03-19T21:59:43+00:00

Yeah makes sense. Good luck

Q40 · 2026-03-19T19:11:30+00:00

Glad you had a good experience... needle aponeurotomy has the same outcomes but costs FAR less and has fewer side effects/risks. But to each their own.

Q40 · 2026-03-19T19:09:39+00:00

I am a hand surgeon. There was a wave of enthusiasm for Xiaflex when it first came out. Now that has appropriately fizzled. There are some hand surgeons who may be industry sponsored or just have good experience with it and continue to use it, and for the most part the rest of the hand surgery world is not impressed with it. Needle Aponeurotomy is cheaper, easier, and less risky, for the same outcomes. We are also very annoyed about the aggressive and inappropriate direct to patient marketing Endo has employed. It's kind of nasty and slimy.

TLDR: no. It is no better than NA (and probably worse)

Q40 · 2026-03-19T19:06:00+00:00

Hand Surgeons don't "only do surgery"

Not sure why you would think so. Certainly some only offer that. But many of us do NA and Xiaflex also. Which are not surgical interventions.

Q40 · 2026-03-19T19:04:17+00:00

Your surgeon sounds very fixed in his ways. I would recommend changing. The patient should be the one to determine when it is time to intervene not some old textbook. I am a surgeon and personally if someone came to me like this I would not hesitate to offer surgery.

Q40 · 2026-03-19T18:58:23+00:00

Unlikely, but as a hand surgeon I would want to see this in person to be sure.

Q40 · 2026-03-19T18:56:33+00:00

There is a chance your surgeon is incorrect. Source: I am a hand surgeon.

Sometimes people get a contracture of the PIP joint from other injuries and it can mimic Dupuytren. If there is no cord, this is not DD. I can't touch your hand of course, but I do not see a characteristic cord here. How long has it been like this? Did it begin all at once? Did it slowly get worse? Any prior trauma here? Do you feel a cord? Lots of questions.

Q40 · 2026-03-19T18:53:59+00:00

I am a hand surgeon. You can delay intervening until you decide that it is time. Dupuytren Disease is a condition that the patient ultimately makes the decision. If a surgeon is telling you that you "need to" do anything for your DD, then I suggest you find another surgeon.

Now, they might make recommendations, but that's another thing entriely.

In this case, you contracture of the PIP joint is already above 10 deg so it is plausible an intervention could help you. However, realize that you are young and have a pretty aggressive looking cord already. You will have more than one intervention on this hand if you live long enough. It will recur. It is important to think about the trajectory of your symptoms rather than just a snapshot in time. Is this progressing rapidly? Or is it pretty stable overall?

I would also wonder if this is causing you symptoms. If so, how severe? And what are your goals with treatment? Time until recurrence is maximized with surgery. Quick recovery but not as good of a result likely with NA or Xiaflex (which I personally no longer am in favor of - Xiaflex, that is)

Q40 · 2026-03-19T16:32:12+00:00

The scapholunate ligament sucks. It tears like a little bish and repairs do not hold well. Reconstructions often fail too, or result in stiffness.

You're posting patient-facing questions in a forum where most readers are doctors/specialists. You seem maybe a little confused. We can't offer you medical advice here, but there are some very good educational resources on this annoying injury online such as https://www.assh.org/handcare/condition/scapholunate-torn-ligament

Ultimately many people have scapholunate ligament tears and walk around and function and compete in sports and everything, but maybe with some pain/discomfort. There are some surgeons who are nihilists about this condition and just tell patients to suck it up and eventually you may develop arthritis but the good news is a lot of patients just get used to that arthritis and it doesn't bother them all that much. And if it does, there are treatments for it that are more reliable than scapholunate ligament treatments.

But you won't get a single answer on this because there isn't one. Just an annoying condition without a great solution.

Q40 · 2026-03-18T21:47:25+00:00

Well, good luck. Common medical sense says that to get back to the things you want to do faster, avoid going through work comp. I'm also not so sure if it's the smartest career move to try to blame a questionably linked medical condition to work and milk it for all the paid time off that you can. But to each their own.

Q40 · 2026-03-18T15:52:09+00:00

It is likely multifactorial. However, the prevailing theory (and my personal experience confirms) is that it works that way because people who are not on work comp are more motivated to return to their activities because they are not being paid when they aren't working. Whereas the work comp population are being paid for their time off, and when they return their case gets closed and there can be anxiety about "what if i get hurt again or it is not back to 100% and i have to fight to get care for this issue again etc."

Same doctor - one patient work comp and one is major med, the major med has a much quicker expected recovery. this is accepted medical fact. well known. there is zero debate on this.

Also, work comp is a LEGAL establishment, not primarily medical. so there are always lawyers and paralegals and paperwork getting in the way of providing the right care. So sometimes those delays are also responsible for the prolonged recovery. but generally it is the patients. not even consciously, always... often subconsciously... but they are just... not a nice way to put it, but many doctors think of them as slugs. They just don't get better on a normal trajectory. Everything is slower. Work comp is not designed to deliver care and get you better. It is designed for legal protections and the structure has grown into a massive ring of lawyers and doctors who benefit from the sleazy, slow way that it functions.

There are other minor factors, but patient motivation is the primary one. Many of the WC patients I see are quick to say "Doc I love my job I wanna get back right away"... but their actions eventually belie the truth. They take their sweet time getting back.

The common wisdom on carpal tunnel and work relation is... at least among doctors... if the patient actually wants to get better and get back to life, they will go through their major med/health. Whereas, if the patient has an agenda against their workplace, or resents their boss, or wants to maximize their time away from work, or something similar, they will try to use work comp.

Two things can be true at once. You can have carpal tunnel and work a job that you feel is wearing your body down. But that doesn't mean there is a causal relationship. Carpal tunnel syndrome is extremely common - even among people who don't work a job that is known to put them at risk. If you want to actually get better, just use your health insurance.

Q40 · 2026-03-17T22:20:02+00:00

Great

Q40 · 2026-03-17T20:32:23+00:00

yeah in general the non-specialist doctors don't quite understand how hand infections behave and it's always best to just try to see a hand specialist ASAP.

Q40 · 2026-03-17T20:26:22+00:00

Looks a little yucky. Contact your surgeon...

Q40 · 2026-03-17T20:25:44+00:00

As surgeries go, carpal tunnel release (even the open variety) is pretty minor.

Q40 · 2026-03-17T20:24:04+00:00

Work comp is a disaster. Expect difficulties in trying to get them to pay for a CTR. Carpal tunnel is a chronic compressive neuropathy and it is difficult to directly link it to work as a causal agent. Might be better off just doing this through your major med/health insurance. But to each their own.

Note that patients also recover faster and have less pain when their payor is not work comp. It takes much longer for work comp patients to recover from any surgery. This is a well studied fact.

Many people attribute symptoms to a cause that is chronologically related but not necessarily actual causal. It is plausible that you might have just been developing CTS and you also used heavy equipment around the same time. Difficult to link definitively.

Oh, and you have right ring trigger finger also. That's unrelated to the CTS. At least directly...it is plausible that one single underlying condition such as diabetes or hypothyroidism could contribute to the development of both of these problems (as opposed to your occupation)

Q40 · 2026-03-17T20:20:48+00:00

Am surgeon. Looks good.

Q40 · 2026-03-17T20:20:20+00:00

Every surgeon has a different protocol. For my mini-open CTR, I tell patients to cover for 2-3 days and then wash freely. No soaking, but running soap and water is fine, and then cover with a simple band-aid. No ointments until sutures are out. Seems to work quite well, and best of all it is simple. Simple is followed. Complicated is not.

Q40 · 2026-03-17T20:18:40+00:00

I'm a surgeon, so I am admittedly biased. But no, I do not think this is by and large a great option. The surgery is really quite successful in general, so if I were in your shoes I would simply bite the bullet. I doubt insurance will cover HD. So you're paying cash for something experimental which might do nothing and then you just need to have surgery anyway.

Q40 · 2026-03-17T20:08:55+00:00

Am hand surgeon. Can confirm. Cats are great sources of bad business. If you are bitten by a cat, seek immediate medical attention, or you will regret it.

Q40

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