Should I wait for my Dupuytren disease to get worse and have more hand surgery?

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?

Thank you,

Robbie Trent

 

Greetings Robbie,

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.

You might want to read, Dupuytren hand surgery can be dangerous: Facts you should know  and  My hands got worse after Dupuytren’s surgery, what can I do?  

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.

 

 

Do Xiaflex injections carry a risk of reduced finger flexion?

I have read after the Xiaflex injection to surgically treat Dupuytren’s contracture that moderate pressure is applied to ‘break’ the cord. Isn’t the cord a thickened tendon? In which case is there a risk of impaired flexion? Just wondered how precise is this breakage and if it would be possible to mistakenly break the tendon altogether. I would be very grateful if you could clarify this for me.

Yours sincerely

L. Al-Nufoury (med student)

 

Greetings L.,

The Dupuytren’s cord is not a tendon.  It is composed of tendon-like material and tissue elements, but it is not a normal or per-existing tendon of the hand.  Is a new structure that develops on top of the tendon, it is not normal for the hand and it is shorter than normal and so causes the affected finger to be flexed toward the palm.

This Dupuytren cord will break where  it is weakened by the fibrinolytic enzymes at the site of the Xiaflex injection.  Sometimes little and sometimes great force is needed to break the cord, depending on the size of the cord and the skill of the surgeon.

A significant limitation of this procedure is that the recurrence of another tendon developing again can be rather fast; Xiaflex injections have a faster rate of Dupuytren recurrence than open or closed surgery options.  For this reason the individual will have to be exposed to additional Xiaflex injections at a later time.  Another problem is that Xiaflex injections can lead to accidental and permanent damage to nearby muscles, tendons, nerves and blood vessels. 

The real risk of impaired finger flexion arises as a result of repeated Xiaflex procedures, when no more can be done since there is a limit to the number of times these injections can be delivered into the same area.    TRH

Any side effects taking the supplements to treat Dupuytrens?

Any side effects taking the supplements to treat Dupuytrens?

 

Greetings,

In over 10 years of work offering help to those who want to use Alternative Medicine as treatment for Dupuytren’s contracture there has never been a report of adverse effect or complications from this method.    The DCI concept is to introduce a wide range of various vitamin, mineral and enzyme supplements to increase the ability of the body to reduce the Dupuytren cord and palm lump.  The DCI method has a high rate of results for this problem when done as we suggest.   

Let me know if I can help you in any way.  TRH

How does a Dupuytren nodule form on the palm?

Dupuytren nodules and cords are different

Dupuytren nodule formation, the first sign of Dupuytren contracture, usually affects males 50 years and over, especially those of northern European descent.  Although the size and shape are variable they are usually range in size from a dime to a quarter, although they can be smaller and larger than this.   Typically a person will first notice a small bump or lump on the palm that increases over time.

Dupuytren nodules are different from other connective tissues of the palm at the cellular level in two ways:  there is an increased activity and growth of two types of connective tissue cells called the fibroblast and myofibroblast; there is greater production of a connective tissue protein called collagen.  As these fibroblasts and collagen are laid down in the palm of the hand, it causes first nodule formation, and later Dupuytren cord formation.  The presence of these two structures is associated with progressive thickening, puckering and adherence to the skin, resulting in palmar fascial contractures and later flexion of the involved finger(s) under the skin of the palm (specifically, the pre-tendinous bands of the palmar fascia).

Dupuytren nodules are different from Dupuytren cords at the cellular level in that there are fewer myofibroblasts and fibroblasts in the cord, and they are irregularly scattered in all directions in the nodules they are in a distinctly parallel pattern in the cord.

The most common site for these palm lumps is at the base of the 4th (ring) and 5th little) fingers.  The Dupuytren nodule at first can resemble a common callus and is often painless, unless touched; occasionally the pain is more significant and lasts for some long while.

Dupuytren lump on the palm

What triggers the Dupuytren lump on the palm nodules to form is still a medical mystery, but seems to be related to liver disease, smoking, trauma and diabetes amongst a few lesser factors.

As the palmar tissue slowly thickens and tightens over months to years, it can develop into Dupuytren cords that flex the involved finger(s) down toward the palm of the hand.  In severe cases the Dupuytren nodules and cords can cause such marked finger(s) flexion that hand function is compromised for common activities of daily living (personal hygiene, dressing, opening a door, putting the hand into a pocket, etc.), so that the individual is functionally disabled.

The progress of Dupuytren nodule development is typically slow, unpredictable and sporadic, without detectible exciting factors.  As the disease progresses over time, the thickened and dense tissue infiltrates between and around normal tissue structures (tendons, ligaments, nerves, blood vessels).

While the medical profession (surgeons) commonly state that the primary treatment option for Dupuytren contracture is surgery to remove the nodule and cord formation, as well as contracted tissue around involved joints, a small but growing segment of the medical profession agrees that non-drug and non-surgical treatment is an effective option that should be attempted before resorting to the surgical route.

For more information how to reverse and eliminate, or at least reduce, Dupuytren nodules and cords see natural Dupuytren treatment.

>> Testimonials from Dupuytren Contracture Institute

>> How to start Dupuytren treatment with Alternative Medicine

>> Dupuytren Contracture Treatment – FAQs

 

Dupuytren Cords

Dupuytren cord causes finger contractures

Dupuytren contracture is thought to be primarily a genetic condition that mainly affects men over 50 years of age, with more aggressive forms starting at an earlier age.  Women also develop Dupuytren cords, but at a lesser rate until age 80 when the occurrence is about equal to men. The process involves excess collagen material that creates Dupuytren cords in the palm of the hand, most often affecting the 4th and 5th fingers.   These cords are nodular in two out of three cases, displaying from one to three nodules when present.

Onset occurs as a palm nodule or bump that many assume is only a callus.  Gradually, over a few or many months, the Dupuytren cord becomes more prominent and the palmar fascia thickens. As the process continues the overlying skin puckers, dimples, and roughens. The thick cords contract slowly over time, drawing the fingers into the palm and may bring adjacent fingers together. The ring and little finger are most commonly affected and usually are affected first when other fingers are also involved.  As is typical of similar conditions in which excess collagen is deposited (Ledderhose disease, Peyronie’s disease, Garrod’s pads) the progression is often erratic, arbitrary, continues in spite of medical treatment, and has no obvious cause.

Dupuytren cords treated with Alternative Medicine

Dupuytren cords are composed of collagen connective tissue right under the skin, in a layer called the palmar fascia.  As the Dupuytren contracture progresses the cords begin to thicken and shorten, causing them to develop a wider display of nodules and folds of thick tissue on the surface of the palm.  Tightening and shortening of the Dupuytren cords pulls the involved fingers down toward the palm in the characteristic hand posture of Dupuytren contracture.

Dupuytren’s contracture is more likely to be found in those who also have epilepsy (anticonvulsant medications are suspected to be the stimulus), diabetes, alcoholism, HIV, liver cirrhosis, and smoking. Trauma and exposure to chronic hand vibration may also exacerbate this condition.

Needle aponeurotomy or more aggressive surgical intervention are the only current medical methods offered to temporarily alleviate some of the outward appearance of Dupuytren contracture.  In spite of having both needle aponeurotomy and surgery, 50% of patients who have either procedure will still experience a recurrence of the palm nodules and Dupuytren cords within two to three years.

There is another option to consider using to slow down or even reduce the size, shape and  density of Dupuytren cords.   The Dupuytren Contracture Institute has specialized since 2002 in the use of Alternative Medicine therapies and techniques that are found to be successful in perhaps 60-80% of cases of Dupuytrens without risk of worsening or side-effects.  Click here for helpful ideas to start a Dupuytren treatment plan with Alternative Medicine.

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