Hello Dr. Herazy,
I am researching the therapies you are recommending. Since I am allergic to Sulfa drugs I probably do not want to use DMSO. Assuming I can tolerate the topical E and the CP Serum is there another carrier oil or gel that I could use instead of the DMSO? Maybe Jojoba oil or olive oil?
Although it is not as good as DMSO for the purpose of driving the topical E and Super CP Serum copper peptides into the Dupuytren palm nodule and cord tissue, you can use Emu oil for this purpose. The emu is a bird from New Zealand and Australia. Oil from this bird has some tissue penetrating properties and can be used also. TRH
In September I had an operation to remove the tendon-like Dupuytren cord from my upper palm and little finger. Developed a good bit of scar tissue as a result can’t bend the finger yet, so lots of exercises. Just yesterday I noticed nodules in my lower palm where the muscles are being used to do the exercises to get rid of the scar tissue. Went to the doctor today and he confirmed a re-occurrence of Dupuytren contracture just six months after my hand surgery. But he says there is nothing to be done until they curl the fingers. Should I be doing something else because I feel I am in early stage with the Dupuytren cord in my palm?
It is not at all uncommon for Dupuytren contracture to recur in less than a year after having hand surgery to remove the palm lumps and cords that are a part of this problem. Yours seems to have come back in six months, which is not rare; I hear a lot of these fast recurrences. I hope your hand surgeon told you all about this. Again, I hear a lot of stories from people who are not told ahead of time about how the Dupuytren contracture will always come back after surgery. These people go into surgery thinking that the hand surgery will get rid of their problem, only to find that is not the case.
Dupuytren surgery will only give a temporary relief from the problem, and sometimes the temporary relief if extremely brief, as in your case. This is very discouraging because the brief relief comes at the high price of months of surgical pain, poor healing, months of painful exercises, all ending with a hand that is not as good as before the surgery and needing more hand surgery anyway.
You need to talk to your hand surgeon about where all of this is headed. You should understand that usually the result of additional hand surgery is not a better hand, but a hand that has even more normal tissue removed resulting in risk of greater pain, limitation of movement, coldness, numbness and weakness. Additionally, you must understand that typically the speed of recurrence of Dupuytren disease after hand surgery increases with each surgery; each operation seems to make the problem come back a bit faster than the one before it.
Notice that at no point do I say that you should not have more hand surgery. I am just cautioning you that not all surgery is successful – like all Alternative Medicine care is not successful. You should ask a lot of questions and be sure of what you are getting into because all of the hand surgery sites warn about the return of Dupuytren contracture after surgery. In my opinion it is better and smarter to first use conservative self-help measures that do not carry the risks of surgery, and only use surgery after all possible conservative options have been used and have failed.
The Dupuytren Contracture Institute has been helping people for over 10 years increase their ability to heal and repair the Dupuytren tissue changes. Some people get dramatic results and some only slow down the rate of progress; every one is happy for the improvement and progress made because it is better than doing nothing but allow the problem to advance on its own. I suggest that you go to the DCI website and read a bit about how you might be able to help yourself.
Successful Dupuytren treatment demands that you know the exact limit of your hand contraction each step of the way
The Dupuytren Hand Contracture Caliper is a requirement for good results with self-directed Dupuytren treatment. You must know how much your hand is contracted and finger movement is limited in order to guide your therapy plan to a successful conclusion. Otherwise you are only guessing about your hand contracture, and that does not help you regain full use of your hand.
People are wrong to only pay attention to the obvious palm lumps and finger cords of their Dupuytrens contracture. The Dupuytren Hand Contracture Caliper makes it easy to know exactly how much their finger contracture is affecting hand movement and flexibility.
The DCI caliper with built-in measurement scale will help you easily and accurately determine reduced finger and hand movement caused by Dupuytrens disease. With it you will document how far your finger contraction is kept flexed toward the palm or wrist, as well as the other important measurement of how far your palm is kept from flattening against a table top or other flat surface. These two numbers are essential baseline measurements to determine progress, or lack of progress, of your self-directed Alternative Medicine Dupuytrens treatment.
If you do not know the true state of your bent finger and hand contracture at the start of care you will never know exactly how much improvement you have made, or if you have made any at all. You must know if you are making actual progress over your Dupuytren hand problem because this information will tell you if and when to change your treatment or perhaps not change it at all.
Many people think, “I’m not stupid. I will know if my finger is improving. I do not need to measure.” But they find after a few weeks of treatment they are totally unsure if the progress they think they have made is real or just a hopeful product of their imagination. Armed with this valuable information you will know if and when to change a treatment plan that is not working, or to keep following a treatment plan that it is working. Either way, for best treatment results you must not guess about any of this.
Using the DCI caliper to measure contracture of the hand:
- The caliper is tightened or loosened by using the large plastic knob at the pivot in the middle. The caliper has two pairs of “legs.” The “inside legs” are used to measure the inner distance of a closed surface, and the “outside legs” are used to measure an outside surface. The inside legs of the caliper are straight but bent only at the very tips to look like the letters “J” and “L.” The outside legs are rounded to look like big pincers or the letter “C.” To measure with either the inner or outer legs the caliper must be positioned so the straight legs are crossed over each other and the curved millimeter (mm) scale to provide a distance reading, just as you see it in the picture, above.
- Adjust the large plastic knob in the center of the caliper so the legs move with moderate resistance; this assures your measurements are accurate. The knob must be loose enough that the legs move with some ease, but tight enough that they do not move once you put them in position.
- Each line on the curved scale represents 2 millimeters (mm). The scale ranges from 0 to 200mm.
- Position the tips of the straight inside legs so the “J” and “L” touch each other. Notice that the edge of the moveable leg touches the “O” on the mm scale, meaning no millimeters. When the tips of the inner legs are 50mm apart the tips of the outer legs are also 50mm apart.
- Either half of the caliper – the “inside legs” or the “outside legs” – can be used to document improvement of your limited finger and hand movement. Use either side or pair of legs that is more comfortable or whichever one works best for your circumstance since the measurement will be the same.
Marking hand and fingers for measurement
Each time the hand is measured the same pair of reference points must be used, and the information must be written down for later comparison using the “Caliper Hand Measurement Chart” you received with your DCI Hand Caliper.
It is best to use naturally occurring landmarks on the fingers, palm or wrist of your hands if they are small enough to make a precise measurement, and if you will be able to easily find the same landmark each time you use the caliper for hand and finger measurements.
Locate a small and easily recognized natural landmark on the involved finger and hand. These two points should be obvious and easily located each time you measure your progress. Carefully place a dot precisely at the point you wish to use each time you measure. Using large dots or different point locations make inaccurate readings that cannot be compared over time, and this does not help you to know if you are progressing or not.
- When taking measurements for the first time write notes or make a quick drawing of the local area that explains each point location in a way that is easy for you to understand and duplicate. For easy reference, write the notes that describe the points you are using on your “Caliper Hand Measurement Chart.
- Mark you skin with a fine felt tip or ballpoint pen to clearly identify the exact points you will use each time to make your measurements.
- Examples of natural landmarks on your fingers, hands or wrists that will increase the speed and accuracy of your measurements:
a. Where a fingernail has a natural vertical ridge or flaw that does not change.
b. Where the fingernail bed and skin touch at the end of the finger (that little corner location where you might sometime get a hang nail). Use the same fingernail corner each time.
c. The very tip of your finger; it is the highest point when you look at your finger from the front and from the side view.
d. At the base of your palm, on or near the wrist crease, find a point where two or three creases meet to form a “V,” “X” or “Y”.
- Slightly bend your wrist. Notice if one or two wrist creases create a nice landmark that will be easy to locate each time you want to measure your progress. A crease or wrinkle of skin may cross over a vein, tendon, scar or blemish, making a precise reference point.
If all else fails you can locate the center of the wrist crease using a ruler, although this is much more difficult and less precise.
Measure distance bent finger flexed toward palm
Each time you how close your finger is kept flexed toward your palm you must use the same two reference points on the finger and palm or wrist. If you have Dupuytren contracture of one finger you will use two reference points. If two fingers are flexed toward the palm of one hand, three reference points are needed (one on each finger tip and a single point on the wrist). Three fingers require four points for measurement. You will make a mark on the fingertip of each involved finger and you will use the same point on the palm or wrist as a reference point for each finger.
- Mark each involved finger – Find a natural landmark or locate the center of the fingertip, as described above, of each finger affected by Dupuytren contracture. Place a small precise mark at each point.
- Mark the palm or wrist – Find a natural landmark or measure for the center of the wrist crease, as described above. This wrist point does not have to be in direct line with the involved finger(s); it can be off to an angle or side of the wrist. The only rule is that you use these same points each time you measure.
a. The wrist point can be located on the palm-side at the center of the wrist, or at an angle off toward the thumb or little finger side of the wrist crease; it can be anywhere on the crease as long as it easy to locate accurately and can be duplicated each time a measurement is made.
b. If two or more fingers are involved on the same hand, the same palm or wrist point is used as the reference point for all fingers of that hand.
c. Open your hand as far as possible.
d. Place the tips of two caliper points (either inner or outer legs) on the small dots you selected at the finger and wrist points.
e. Write the millimeter (mm) distance, as shown on the curved caliper scale, on your measurement record.
Measure amount of hand contracture
Each time you measurement your inability to flatten your hand on a tabletop, you must use the same two reference points.
If you find that only one side of the hand is kept from flattening out, and the other can be made flat, then you need to only measure the side that cannot be flattened. If both sides are kept from flattening, then you should measure both the little finger and index (pointing) finger side of the hand.
- Locate a deep wrinkle or crease that is near the knuckle that cannot be flattened. Place a small dot at the end of the selected crease or wrinkle to serve as the landmark or reference point for that joint.
- Mark the side of the finger joint or knuckle that cannot be flattened against the table top. The 1st point can be anywhere on the side of the knuckle that is a naturally occurring landmark; it does not have to be in the center of the joint.
- The 2nd reference point in this measurement is the tabletop the hand is resting on, and therefore does not have to be marked.
- Place your hand on a table top or similar surface. Press the hand down firmly so the palm is as flat as you can make it.
- Using one leg of the inside caliper (with the long straight legs), allow it to touch the dot on the side of the knuckle.
- Using the other leg, place the tip on the flat surface directly below the mark you placed on the knuckle being measured. Do not place the tip of this leg at an angle or far from the knuckle being measured. If you are not careful with this tabletop point selection you will add a variable to the measurement that will make comparison of other measurements invalid and inaccurate.
5. Write the millimeter (mm) distance, as shown on the curved caliper scale, on your measurement record.
6. To measure the distance the joint on the other side of the hand is being kept from flattening against the tabletop, repeat steps 2-7.
This is the measurement form that comes supplied with the caliper to record increased finger and hand movement. You will need good records because they are essential to know when to alter your Dupuytren treatment plan and how to do it.
© Copyright 2004-2012. Dupuytren Contracture Institute, Arlington Heights, IL 60004, and Online Natural Healthcare LLC All rights reserved. Unauthorized use or copyright violation, without written permission, will be prosecuted to the full extent of the law.
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.
Recurrence of Dupuytren contracture is common and impossible to predict
In general, Dupuytren contracture recurrence means that is spite of hand surgery, the shortened, thickened tissue appears to return to the area of previous surgery, but actually is a continuation of the extension or progression of the disease into tissue previously unaffected. Many surgeons openly speculate that Dupuytren contracture surgery accelerates the rate and extent of the disease progression.
In broad terms, the rate of Dupuytren’s recurrence after needle aponeurotomy (palmar fasciotomy) is considerably higher than for traditional open hand surgery (palmar fasciectomy).
Avoid surgery if possible with natural Dupuytren treatment
Any type of hand surgery done to release the contractures of Dupuytren disease can eventually result in the return of more contractures. This recurrence if followed by another hand surgery can result in the return of more contractures eventually. While this cycle of surgery and reappearance of more contractures proceeds, the patient is exposed to the potential risks of hand surgery each time it is done: permanent numbness, reduced finger movement, reduced hand strength, reduced sensations and pain.
To avoid this cycle the patient should consider the use of a brief therapeutic trial of Alternative Medicine as a conservative and essentially risk free option that could make surgery unnecessary.
Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation in the palm. Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider conservative treatment options before attempting irreversible surgery. To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment
What is Dupuytren contracture recurrence?
The wide range of recurrence rates represent only gross estimates because there is no formally accepted definition of this term, so what characterizes a reappearance of Dupuytren contracture varies from one study or doctor to the next. Recurrence of Dupuytren contracture can be:
- A finger or hand that received a prior Dupuytren surgery had to be operated on again for any one of a variety of reasons.
- The condition of a finger or hand worsened after hand surgery, without evidence of even initial improvement. Sometimes the worsening is determined to be any degree of flexion deformity greater than prior to surgery, and sometimes must be a 5-10 degree increase.
- The condition of a finger or hand was initially good after Dupuytren surgery, but after time some degree of finger flexion returned to that finger or hand. Sometimes the return is determined to be any degree of flexion deformity greater than the level of correction initially provided after surgery and sometimes it must be a 20-30 degree increase greater than the level of correction initially provided after surgery.
“The greatest French surgeon of the 19th century,” Guillaume Dupuytren, battled with the problem of reappearance of this disease after surgery. He experimented with a variety of tactics and methods to minimize the return but none were totally successful, just as it is today.
How often does Dupuytren contracture come back after hand surgery?
The general consensus is that after having conservative surgery by needle aponeurotomy, 50% of patients see a return of the same or worse contracture just three years later. But after having more invasive open hand Dupuytren surgery, 50% of patients will notice a reappearance of the same or worse contracture five years later. It seems that Dupuytren contracture will tend to come back over time to the same 50% group, but for needle aponeurotomy patients it happens much sooner.
In 2011 the partial fasciectomy is still the most common surgery for Dupuytren contracture. In this operation the diseased tissue is completely removed and perhaps parts of the palmar aponeurosis might also be excised. In 1990 McGrouther reported after this kind of surgery anywhere from 2 to 63% of surgery patients will have their Dupuytren tissue changes reappear, while in 2007 Schwartz reported 44% recurrence after these same surgeries.
MedScape News Today reported in February of 2011 that contracture recurrence rates range from 27% to 80% after palmar fasciectomy (open hand surgery), and are highest when this technique is used on the PIP joints of the fingers. This same Medscape commentary reported 65% to 85% contracture problems recur after palmar fasciotomy (needle aponeurotomy).
Little information for laypeople about Dupuytrens returning after hand surgery
Many patients research on the web or elsewhere for information about Dupuytren contracture surgery. Usually they find little information explaining that the palmar nodes and cords often reappear a few years, sometimes as soon as one year, after surgery. While attempting to learn about Dupuytren surgery from a medical website – and recurrence in particular – the reader will often encounter only a single sentence that mentions the word “return” or “recurrence,” with rarely any discussion or statistics to explain the scope or frequency of the problem. A large medical website promoting palmar fasciectomy or needle aponeurotomy might only comment, “After surgery, a therapy program of massage, wound care, exercises and night time splinting is important to get the best possible result and prevent recurrence.”
While it can be said that such a website does inform people about the possible return of Dupuytren contracture after surgery, the usual mention is so vague and casually presented that a potential surgical patient will not understand the rather high rate at which the nodules and cords come back after being surgically removed. With limited information being the norm it is difficult for anyone to develop a clear understanding of how often, how quickly, and how problematic is this return of the Dupuytren’s contracture problem after undergoing a surgical release of the constricted fingers.
It is almost as though the popular medical information sources are reluctant to reveal that while Dupuytren surgery can improve the palm and finger contractures for the short term, the results are somewhat temporary and have no beneficial effect on the eventual progression of the disease.
This would explain why over the years the majority of people I encounter through the Dupuytren Contracture Institute are completely surprised and unprepared when they have a reappearance of their hand contractures after surgery; most thought that once they had the hand operation their problem was solved and would not come back again. Over and over I learn these people were not told about Dupuytren’s recurrence by their surgeon, or that the idea of needing a second operation was presented as a genuine rarity. It is a serious problem when patients cannot provide informed consent for their hand surgery because they have not been given adequate information about the post-surgical return of Dupuytren nodules and cords.
Final comment, Dupuytren reappearance after hand surgery
In 1964 Weckesser stated. “In general, the longer the follow-up period [after Dupuytren’s disease surgery], the lower the percentage of good results.” This means, of course, that surgery for Dupuytren’s contracture does not stop the disease process or prevent its return, but only provides a temporary break from the contractures. This would not be too bad if the time between surgeries was longer or if side effects, or complications from surgery did not make the problem worse for some patients over time.
Better to avoid the first hand surgery if possible.