What is the difference between a Dupuytren’s nodule and Dupuytren’s cord?
Which is worse if you have Dupuytrens, cords or lumps?
Dupuytren’s contracture, sometimes called Morbus Dupuytren (MD), is a benign (non-lethal) process in which excessive collagen causes the connective tissue (fascia) to thicken in the palm of the hand; this is later followed by shortening of that same tissue. As Dupuytren contracture continues, the tissue alters appearance and normal hand function is reduced. The progression of the problem is fairly straightforward and clear, but the causes and reasons for the various cellular changes involved in the thickening and shortening remain unknown.
There are two well known physical elements of Dupuytren’s contracture. First, is the appearance of one or more nodules or lumps on the palm of the hand; the palm is sometimes dimpled or puckered over the nodule. The other is the development of a tight cord-like structure under the skin of the palm. It has been proposed in recent years that as Dupuytren contracture progresses the various cells and tissue elements of the early nodule convert into the later cords.
Natural treatment of Dupuytren’s contracture
Surgery is not always necessary to remove these palm lumps and cords. Since 2002 the Dupuytren Contracture Institute has worked with people from around the world to use natural Alternative Medicine methods instead of a hand operation. While surgery is always an option if a brief trial of natural methods is unsuccessful, most people prefer to first use non-surgical treatment to possibly avoid the inherent risks of surgery.
Dupuytren nodule, lump or bump
One or more lumps or nodules are usually noticed when they are rather small and soft, and not firm and solid feeling as they will become later. Often the nodule is located in the flexible area of the skin in the vicinity of the diagonal crease at the base joints of the fingers. When a nodule appears in the lower palm, further down towards the wrist, involving a structure known as the palmar aponeurosis, it typically is less likely to become contracted and lead to reduced hand function and forced bending of the involved finger.
One or more lumps or nodules are usually noticed when they are rather small and soft, and not firm and solid feeling as they will become later. Often the nodule is located in the flexible area of the skin in the vicinity of the diagonal crease at the base joints of the fingers.
In most cases the nodule will appear at the base of the ring (4th) and/or little (5th) finger, although the middle (3rd) and index (2nd) finger are occasionally affected, while the thumb is rarely affected. A Dupuytren bump or nodule can also appear throughout the palm, sometimes in the digits, and in rare cases elsewhere. When a nodule appears in the lower palm, further down towards the wrist, involving a structure known as the palmar aponeurosis, it typically is less likely to become contracted, or lead to reduced hand function and forced bending of the involved finger.
Pitting and dimpling of the palm of the skin near or within the nodule can also develop during the early phase of disease progression when the lump changes the way underlying fascia connects to the skin.
These Dupuytren bumps or lumps are usually painless, especially during the later phases of the disease progression. When pain does occur later it is because a lump or nodule presses or rubs against a nearby tendon. As the disease progresses and finger contractures begin, the nodules tend to reduce or disappear.
Dupuytren nodules or lumps are frequently mistaken for calluses because of their location on the palm near other calluses, as well as appearance, general density and adherence to the skin like a callus.
As Dupuytren’s contracture slowly progresses and nodule progression goes from small and soft to large and hard, the next stage is the development of long thin bands of collagen tissue located near and parallel to tendons. These tough rope-like structures, made of collagen connective tissue, are referred to as Dupuytren cords.
They start out from the pre-tendious bands that are extensions of the normal palmar fascia and eventually thicken over time as the disease progresses. For this reason the Dupuytren cord will develop parallel and near to the tendons of the hand and fingers.
Typically the tissue changes of Dupuytren’s disease tend to stabilize temporarily at some variable mid-point; for some people this can occur within a few months or even years after onset, and remain inactive for months or many years, typically 5-6 years.
Sooner or later at around this 5-6 year point additional nodule or cord growth development starts again at a variable speed and finger contracture worsens. This is about the time during Dupuytren’s disease that patients become serious about treatment. Eventually as the palmar tissues continue to thicken and shorten, the tendency increases for these structures to pull the involved fingers down or flex toward the palm. Over time, as the finger remains flex toward the palm, the muscles that straighten or extend the fingers become progressively weakened and eventually undergo atrophy. The overall effect is a hand that is progressively held in a flexed position.
Common daily tasks become increasingly more difficult to perform as the range of finger movement decreases and the degree of contracture increases. Dressing, bathing, toilet, operating an automobile, amongst other many other activities of daily living, are adversely impacted to a degree equal to the numbers of fingers affected by a Dupuytren nodule or cord, and the degree of fingers held in flexion.