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.
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.
I have DC in both hands, and have had surgery on same finger twice in 13 months. I am 65 and have many lumps, etc (pretty aggressive).
My question concerns the pain in both hands, generally when I have become overly tired. Is the pain related to DC or could it be another problem going on?
Most often the hand pain felt when a person has Dupuytren contracture is indirectly related to the presence of the abnormal tissue.
You report your hand pain occurs when your hands are fatigued. When I see this happen it is most likely due to the fact that your forearm and hand muscles are working at a great disadvantage due to the presence of nodules and cords in your palms. With your fingers flexed, and the nodules and cords affecting the way you use your hands to do daily activity, your body is not working as it was designed to do. You work harder to do simple things. Still you do what you have to do during the course of a day, and this is a burden that causes pain and easy fatigue of your upper body.
However, it would probably be best for you to see your doctor to confirm this idea in your case. Always check with your doctor. TRH
Dupuytren treatment with radiation therapy for small hand nodules only
Dupuytren radiotherapy is the medical use of low-level x-ray radiation directed specifically at the involved hand lump and nodules, spread out over several sessions with a few month interval of non-treatment between each. The effectiveness of Dupuytren radiation rests on its use as a preventative measure when used early in the disease process to prevent progression, not as an active treatment for later phase hand contracture.
Dupuytren radiotherapy is a fairly recent innovation for medical treatment of Dupuytren contracture before it evolves into finger contractures and limited hand usage; all other medical treatment is applied later in its progression.
According to the German medical clinics who are currently performing the bulk of these procedures, Dupuytren treatment with radiation therapy has a favorable outcome and is said to be able to stop the development of a tiny bump in palm either permanently or for a reasonable length of time; they report that occasionally the Dupuytren nodules disappear entirely if they are tiny when treated. The significant drawback of Dupuytren radiotherapy is that once someone with Dupuytren contracture develops finger contracture or bending, this procedure is not able to produce any tissue changes. It is not clear why clinics or universities in the U. S. are not performing Dupuytren radiotherapy.
Radiotherapy for Dupuytren contracture
Generally, radiation therapy (RT) is that branch of medical practice concerned with cancer treatment by means of high-energy beams of ionizing radiation directed at the intended diseased target tissue. RT functions to server to control cancerous tumor growth while limiting and minimizing radiation exposure to the adjacent normal and healthy tissue.
The most common technique of radiation therapy for Dupuytren contracture is to deliver one radiotherapy series of five sessions performed five days in a row, in which five GY of radiation are delivered, followed by a pause in therapy that could be anywhere from six to 12 weeks, after which another radiotherapy series of five sessions performed five days in a row, in which five GY of radiation are again delivered. Some medical clinics deliver 3 GY or 4 GY daily for a five day total series dose of 15 GY or 20 GY.
A GY (gray unit) is the international system (SI) unit of an ionizing radiation dose expressed in terms of absorbed energy per unit mass of tissue. A gray (GY) is the unit that expresses the absorbed dose of radiation. The GY has replaced the older term, rad. Now, one GY equals to one Joule/kilogram and also equals 100 rad.
Radiation therapists who perform this treatment justify its use in Dupuytren contracture explaining that radiation damages a special soft tissue cell, the fibroblast, which is an important cellular component for the progression of the disease. Yet, this same group of doctors admits that it is very difficult to find scientific evidence to prove that radiation selectively destroys or alters fibroblasts. They also admit radiation therapy is unproven for Dupuytren contracture since it is impossible to collect verifiable data about their controversial therapy because hand nodules and cords are known to be dormant or stagnate for months or years at any time during the course of the disease, with or without Dupuytren treatment.
Interestingly, it is in the guidelines of the German Association for Hand Surgery (Germany is where most Dupuytren radiotherapy is performed) that call this use of RT in Dupuytren treatment as obsolete and out of use. Among the reasons for their position is the potential for negative unintended consequences of radiation therapy:
- Radiation burn injury to the skin
- Cumulative radiation exposure from and/or treatment either before or after Dupuytren RT may cause cancer
- Unknown consequences of this procedure, such as interference with later surgery of the hand due to tissue weakness created by the RT for those who do not respond favorably
- Very few clinics or facilities that perform this procedure have sufficient experience and knowledge or correct equipment, to perform Dupuytren radiotherapy –yet do so.
As a result of RT exposure those who conduct this procedure report a typical softening of the nodules or cords so treated that prevents later contraction of the hand.
A significant difficulty of Dupuytren radiotherapy is that few people consult a doctor in the very early stage of Dupuytrens when this method of treatment is primarily beneficial. Dupuytren RT is not used after the hand nodules are larger than a few millimeters across.
If your Dupuytren contracture is advanced beyond the early stages, or you are not interested in using ionizing radiation as a treatment option, consider Alternative Medicine to reduce the density and contraction of your Dupuytren hand problem.