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 Contracture Treatment – FAQs

>> Testimonials from Dupuytren Contracture Institute


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.

Dupuytren cord

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.

What is the best therapy to treat Dupuytren contracture?

How should I treat my Dupuytrens disease?

“What is the most important product or vitamin I should use to treat the Dupuytren lump on my palm?”  I am asked that question frequently.

The correct response is that there is not any single therapy that is more important than the others; they are ALL important, especially when used together.  Each natural therapy product if taken by itself has limited ability to make a difference with the dense fibrous Dupuytren contracture tissue on the palm of the hand or fingers. However, when they are used together as we advocate at DCI, their combined effort we find is capable of generating a healing response. None when used separately will achieve the clinical results that compare to a broad-based synergistic approach to Dupuytren therapy using Alternative Medicine.

There is simply no way to predict which vitamin or mineral or enzyme therapy will do the most for you, if in fact any can make a difference to the contracted tissue when used alone.    There is no one product that can cause the contracted palmar fascia tissue to be reabsorbed by the body.

Treatment of Dupuytrens like playing baseball – you need all players

It is similar to determining something similar about a baseball team.  You cannot ask “What is the most important position on the team?” and expect a meaningful answer.  Certainly some would answer, “Oh that is easy.  The pitcher is the most important player.”  If that were true, you only have to imagine how much trouble a team would have if there was no short stop or catcher or first baseman, or center fielder on a team, or if you tried to play a game with nine pitchers on the field.  Each player is important in his own way and vital to the ultimate success of the team when they work together.  The same is true with treatment of Dupuytren contracture.

Please read and re-read sections of the DCI website that describe the treatment philosophy and the principle of synergy, found at Dupuytren Contracture Treatment Philosophy.    If you are having any concerns or indecisions about what you are doing while using Alternative Medicine to treat your hand lumps, you owe it to yourself to go over some of these points. Educate yourself well about this terrible problem and come to understand exactly why you are following this course of Alternative Medicine care.

There is a lot of good information for you on the DCI website.   If you haven’t already spent considerable time reading the background and principles that explain why this therapy works for so many people, now is a good time to review what started you thinking in this direction in the first place.  After you understand more about the philosophy that guides this process of eliminating the dense contracted hand tissue, it will be easier to successfully create and follow your own Dupuytren treatment program.

Why you should think twice about Dupuytren’s surgery

Specific reasons to be wary of hand surgery for Dupuytren contracture

Few people are overly eager to have surgery for Dupuytren’s contracture simply because they are not comfortable with the cutting and bleeding associated with any surgery.  However, there are specific and unique complications and side effects that occur as a result of surgery for Dupuytren contracture that should stir even more caution.

Because Dupuytren’s surgery, even when done well, can lead to unsatisfactory results and stimulate the recurrence of new cords and nodules in the palm, the Dupuytren Contracture Institute since 2002 has proposed the use of conservative non-surgical and non-drug methods to help the body reverse and even eliminate the Dupuytren nodules and cords.  For more information please see Different Way of Looking at Dupuytren Contracture Treatment

Limitations of Dupuytren surgery

Each Dupuytren surgery candidate must remember there are limitations to what can be accomplished in this kind of hand surgery:

1.  Every Dupuytren patient thinks, “I will get this surgery for my Dupuytren problem and then I will be OK.  I will be normal again.”  That is not the case.  Surgery will not restore the hand to its original condition.  Even though surgery might remove all or some of the diseased tissue, Dupuytren contracture is notorious for recurring in a few yesrs.

2.  After Dupuytren’s hand surgery complications (greater pain, greater loss of hand/finger mobility and dexterity, hand coldness, numbness, sensitivity to pressure and touch) occurs in 20-50% of cases when nerves and blood vessels are cut, and scar tissue develops.

3. After any of the different palmar fasciectomy types of surgery there is less normal tissue in the hand, even when healthy skin is grafted in to close the open wound and replace diseased tissue.  Since the graft comes from another part of the body, it will react differently when in the palm. If a tissue graft is not used, it is necessary to reconnect open wounds, resulting in a hand that has less tissue in it. This results in reduced finger and hand movement, reduced hand strength and alteration of the tissue bed that nerves and blood vessels lay in, resulting in a hand that is “better before the hand operation, but still not right.”  This outcome is common, and all people I speak to are surprised because these things were never explained before the Dupuytrens operation.

4. Given enough time – usually just a few years and sometimes a little as one – Dupuytren contracture will likely recur again at the same site as a prior surgery, or in tissue adjacent to prior surgery. This idea of post-operative recurrence of Dupuytren contracture makes many wonder why bother having the surgery if the problem will recur and additional surgery will be needed.

For these reasons DCI contends it is better to be conservative first, and then try aggressive Dupuytren surgery later if it is still needed.

Reality of Dupuytren’s surgery

When a patient with Dupuytren contracture speaks to a hand surgeon the doctor will often say something like, “This will be a really simple surgery.  I have done hundreds over the last 10 years. The results are very good.”   Any potential surgical patient would like to hear that while trying to decide to have surgery for Dupuytrens.  That is why the doctor would say it that way; to make it easier for the patient to decide to have surgery.

Of course the doctor says the hand surgery is simple and easy from his or her standpoint; it probably is compared to other surgeries.  What the patient might envision after hearing it is a “simple surgery” would be to minimize the process to make it easier to accept the idea of having it done.  The patient would tend to think, “The doctor said it is a simple surgery, so maybe it is like when I had my tonsils removed or when I had that boil on my back lanced.  Those were pretty simple, so maybe this will be just like that.”  And of course, nothing could be further from the truth.

It is always wise to have surgery done by someone considerable with the same kind of problem – the longer the time and the greater the number of surgeries, the better.

But, from my experience, when a surgeon comments that the results of a particular hand surgery are “very good” or a similar expression, it would be wise for the potential patient to ask a few questions to clarify what the doctor actually means.  When a doctor thinks the surgical results of a palmar fasciectomy are “very good,” the doctor has something else in mind that is much different than what the patient is thinking.

The doctor is thinking soberly about the current level of the patient’s problem in terms of greatly limited hand use and degrees of joint deformity.  The doctor might consider the operation to be highly successful because before surgery the little finger was locked at 80 degrees and after surgery for Dupuytren’s contracture the little finger is at 20 degrees flexion.  To accomplish this increase the doctor might not be disturbed that his surgery also resulted in pain and numbness that the patient never had before, or weakness that causes him to be unable to open doors with that hand.   The doctor might not also be bothered that his patient will again have recurrence of Dupuytren contracture in that same finger a few years after the first hand surgery.  In spite of this the doctor will contend the surgery results were “very good.”

The patient is thinking emotionally about what the doctor said in relation to the “very good” results of his proposed surgery for Dupuytren contracture.  For the layperson “very good” means almost like brand new.  Full range of finger movement; being able to put his hands in his pockets again, brush his teeth and comb his hair like a normal person, and all the things he did before he developed Dupuytren contracture. And, of course, this patient is not even remotely thinking about developing new problems like pain and numbness after surgery. Lastly, the patient will be most surprised when the Dupuytren contracture returns in a few years, usually worse than the first time. How could any of that happen if the doctor said the results are “very good”?

Not against surgery for Dupuytren contracture

With no drug treatment for the contracted hand tissue, traditional medicine offers Dupuytren surgery as their only cure. DCI is not against surgery for Dupuytren’s contracture.  DCI’s position has always been to recommend surgical intervention in those cases that have not responded to an aggressively applied round of conservative Alternative Medicine therapy.  If someone has attempted to reverse or reduce their hand contracture with limited results then they should seek out an evaluation of two doctors who specialize in Dupuytren’s hand surgery.

Yet, people often approach the management of their Dupuytren contracture in the reverse order:  They first receive one or more surgery for their Dupuytren’s problem and upon seeing the limited response or worsened condition they are in, will only then think in a conservative direction.

People from around the world report to DCI that they rushed into their hand surgery thinking it would be an easy and sure solution to their palm nodules and contractures.  This is often not the case; in some cases their hand is worse after Dupuytren’s surgery.

It is DCI‘s opinion that it is safe and reasonable to attempt to improve the body’s ability to heal and repair the problem of Dupuytrens contracture by aggressively using several conservative Alternative Medicine treatments that are based on sound science and common sense. We strongly suggest that anyone with Dupuytren contracture works with what is known and what is available – even if it is not perfect – before undergoing potentially risky surgery for Dupuytren’s disease.   If DCI’s conservative concepts do not help your hand lump, you can always have Dupuytren surgery later.

 

When to have Dupuytren surgery?

Hello Dr. Herazy,

I have spent a few hours studying your interesting website.   Thank you for making such a helpful website available that presents a different side of the story about what a person should do for Dupuytren’s disease.

I have many questions right now, but I suppose my biggest is  “how does a person know it is time to actually have Dupuytren surgery?”

Thank you,

Lela from Delaware

Greetings Lela from Delaware,

From a medical standpoint there are a few very standard and simple tests that are generally used to determine who is and who is not a good surgical candidate – although this decision should not be made solely on the basis of a few numbers and angles, and a simple tabletop test.

Generally, Dupuytren surgery should be reserved for those who have hand contractures that keep the involved finger(s) at 30° flexion, or when the individuals has a positive tabletop test in which both the palm and fingers  cannot be held flat against a tabletop.  This makes the decision sound easy, but there are many more things besides age, past surgical history and the state of general health  to consider.

In my opinion, when considering to undergo a Dupuytren release it is good to remember that no hand surgery for Dupuytren offers a permanent correction; all are a temporary solution because recurrence of Dupuytren contracture will happen sooner or later, usually within five years or so.

A Dupuytren release involves making one or a series of incisions into the palm to remove the dense, thick, contracted and inflamed soft tissue (fascia) that surrounds, supports, and separates the tendons and tendon sheaths of the fingers and hand, while preserving the arteries, veins and nerves, correcting joint deformities, preserving uninvolved skin, and maintaining proper flexion and grip strength.

A Dupuytren release does not cure or eliminate the disease.  When it works out well it only temporarily modifies the progression of the disease and temporarily improves hand function. When it does not work out well it can result in a worse problem than before the release surgery.  Recurrence is still likely after Dupuytren surgery.

The time to have Dupuytren surgery is when you have attempted to do every thing you possibly can to avoid it, and you have been unsuccessful.   Additionally, there should be a strong feeling that you are willing to accept the risks involved and tolerance for the idea you might have to have additional hand surgeries in the future.

Before you submit to hand surgery I suggest that you attempt at least a few weeks of an intense program of natural therapies that we describe in Dupuytren Contracture Institute website.  For a good place to start reading and learning, go to Start Dupuytren Contracture Treatment

What is the best therapy to use for Dupuytren treatment?

Dr. Herazy,

I want to ask you, of all the different vitamins, enzymes and things that you use to help get rid of Dupuytren what is the best one to take?

Helen

Greetings Helen,

Thank you for the question.   Your question is probably the most common one I receive about Dupuytren treatment.    Many  people would like that  answer, and so would I.

All of the therapy items found on the DCI website that you read about have the potential to be effective against Dupuytren contracture.   You ask a specific question about which specific therapy being able to help Dupuytren the best.   However, that is not the way DCI recommends to treat Dupuytren contracture; it is totally against what we have found to work the best.   The prime idea of successful Dupuytren treatment is not to focus on one particular therapy, even if it is a great one.  Since 2002 DCI has helped men and women get results with Alternative Medicine by using a variety of different therapies in an attempt to create a synergistic effect for maximum therapeutic effect. 

Please go to the DCI website Store Front to see a few examples of some good and balanced therapy plans.  If you do not want to use any of these, you can create a plan of your own.  When you do, keep in mind that the more variety in your plan the greater the synergistic effect that you will have working for your recovery.

Any one of the 10-12 Alternative Medicine therapies found on the DCI website could be a complete treatment (or NONE of them could be a complete treatment) depending on the individual, but it is not likely.  No one knows how a person will respond to any or all of the therapies.  Some people report fair results with just one therapy, but more people report better results when they use multiple therapies.  That is what the whole therapy concept of synergy is all about:  the more you do, the wider the base of your therapy,  the larger your plan, the greater the likelihood of promoting a favorable change in your metabolism and increasing your immune response to reduce the lumps on the palms that bother you.  Re-read that last sentence.  The idea is not to “treat the hand contracture” as a medical doctor would do, but to “treat the person who has the hand contracture” so that his body can heal what is wrong with it.

This is a major concept shift for medically indoctrinated people.  For this reason, as good a single therapy as Neprinol is, or acupuncture, or vitamin E, or any other, I do not recommend that anyone who is interested in getting good results with Dupuytren treatment should use just a single approach or just any one product – but multiple therapies to create synergy.

Those who report the best results with their palm lumps are those who follow the larger treatment plans and use them aggressively and faithfully.   It is most important to approach your problem from as many different directions at the same time as possible. You must read over a good part of the DCI website to understand about the total Alternative Medicine approach to promoting your ability to heal and repair your finger and hand contracture.  I cannot explain in a single response what is covered in detail on the website, so I encourage you to go there for information.   Good DCI pages to read are Introduction to Dupuytren Contracture Treatment and Dupuytren Contracture Treatmtent Philosophy and Dupuytren Contracture Treatment: Winning or Losing

Dupuytren contracture is a tough problem to live with and a difficult problem to treat.   It requires dedication and persistence to overcome it.   I have worked with many people who had their problem for five to ten years or more, and have done quiet well.  It is never easy to overcome, but always worthwhile.

The biggest advantage in ordering your therapy products from DCI is that we provide such a level of service and background of experience working with Dupuytren contracture that you will not find anywhere else.  Each product that is shipped to you that requires additional information to use properly comes with detailed instructions so you will know how to use it correctly.  You cannot expect that kind of vital Dupuytren treatment information anywhere else.

Please stay in touch.  I applaud you for reaching out for help.   You owe it to yourself to please follow through.

TRH

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