22 June 2021
A pioneering surgeon has taken the procedure to treat Dupuytren's contracture, a condition which makes the fingers curl into the hand, out of the operating theatre and into the outpatients’ clinic.
Mr Murali Bhat, Consultant Orthopaedic and Upper Limb Surgeon is the first of his peers to perform this corrective surgery in clinic which has meant patients can be treated in around 45 minutes and recover quicker. One of Mr Bhat’s first patients was tennis coach Dave Earl.
What the patient says
Dave Earl, 39, has been playing tennis since he was 7 years old and was inspired to pick up a racquet after watching Boris Becker at the Wimbledon championships in 1988.
He is the head coach at Redhill Lawn Tennis Club in Surrey and has twice won the LTA’s Surrey Coach of the year. Every week, except for COVID lockdown restrictions, he normally clocks up 40 hours of tennis and says: “If I’m not coaching or playing tennis, I am watching it.”
But, about eight years ago, his little finger and ring finger on his right hand started to turn in. He began to lose his grip and struggled to hold the racquet properly. It took a while before he could have his hand diagnosed properly, but eventually was told it was Dupuytren's contracture. This is a condition which produces abnormal scar tissue under the skin of the palm and fingers. Knots of tissue form under the skin, eventually creating a thick cord that can pull one or more fingers into a bent position.
Dave kept putting off the operation but 18 months ago, he started to get cramps in his hand because the other fingers were overcompensating, and he lost the ability to change his grip during play.
“The cramps were making it impossible to play. I was cancelling lots of lessons, had stopped having matches and was beginning to worry how much work I could continue to do.”
Outside of tennis, he struggled to pick up his two-year-old son, to do DIY jobs, and even found it difficult to hold a two litre bottle of water.
“Shaking hands was out of the question but as we were going through the COVID pandemic I didn’t need to do that,” he says.
Dave was put in touch with Mr Murali Bhat and had a phone consultation and sent photos of his hand to the surgeon.
“He was so reassuring. He told me the operation would take 45 minutes and I could be back on a tennis court in 3 weeks.”
The operation took place on Monday 26 April and lasted just 40 minutes.
“I watched the operation and got a close-up view of the inside of my hand. Mr Bhat kept me completely updated about what he was doing throughout, and we spoke all the way through about sports and diet.”
“I watched as my fingers finally opened - my hand hadn’t opened properly in seven years. It was amazing!”
After the dressing came off a week later, Dave was able to hold a racquet and says he could feel his two fingers engaging in the grip. After 5 weeks he was back to playing 40 hours of tennis a week.
“I am back on the court properly and have joined in team practices. I can feel the ball off the strings and can manipulate the racquet - I am absolutely flying!”
What the surgeon says
“Dupuytren's contracture is a common condition and in the over 60s, can affect 1 in 5 men and 1 out of 8 women. It is a painless condition and can be mild, as in Dave Earl’s case, or to a point where all the fingers are curled in.
But it can affect people’s quality of life, as they can’t fully open their hand. It becomes hard to do simple things like washing your face, pulling on gloves, putting your hand in your pockets, or even holding a pint of beer.
While it is more common in older people, you can get early onset Dupuytren's contracture, mainly in white men in their 30s. As Dave discovered, it can lead to other problems such as cramp as the remaining fingers overcompensate.
The procedure to release the fingers can take as little as 20 minutes in mild cases and as long as 6 hours for more complicated procedures. For this reason, I like seeing patients in clinic first (video or face to face), to determine if they're suitable for outpatient surgery. I know that I'm unique in taking the mild cases into outpatients and I know some surgeons prefer to be in a main theatre, but I have been doing hand surgery for 16 years and felt experienced and confident to do this - and the benefits for the patient are huge.
For a start, in these current times, they don’t need to self-isolate for three days beforehand because they are not coming into theatre. Once they clear the basic outpatient screening questions for the absence of Covid-19 infection, they simply need to use an antiseptic gel on their hands, wear a mask and maintain social distancing. They come in for a specific time, so if it is 9.15am they know they will be out by 10am.
The outpatient method uses the WALANT technique – the patient is Wide Awake, with a Local Anaesthetic and No Tourniquet. It avoids the patient having to have the discomfort of a tourniquet, their recovery is quicker, and it is significantly less expensive for them. I started outpatient surgery for a number of different orthopaedic conditions a year ago. I feel proud that we have not had a single infection yet.
They go home in a sling but need to move their fingers and keep their hand elevated and dry for a week. I see them in clinic a week later to remove the dressing and after that they are encouraged to massage the scar.
Recovery is two days to two weeks for someone in a desk job and around six weeks for a manual worker. The scar will be a little bit red and lumpy for a while, but after 6 to 12 months you will hardly be able to see it.”
Advice from Mr Murali Bhat, Consultant Orthopaedic and Upper Limb Surgeon at Spire Gatwick Park Hospital. If you wish to book a consultation with Mr Bhat, please call on 01293 778 906 to find out more.