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

 

If it is not Dupuytren contracture what else could keep my finger bent down?

Dupuytren Contracture and Similar Conditions

There are actually only a few different conditions that might be confused with Dupuytren contracture.

These are the primary hand conditions, other than Dupuytren contracture, that can prevent the finger from straightening out from a flexed position:

  1. Trigger finger – this is the sticking and sudden release of restricted flexor tendon in the sheath that also commonly as an associated aspect of  Dupuytren’s contracture
  2. Ulnar nerve injury – results in a “claw hand deformity” of the entire, due to lack of extensor muscle function
  3. Extensor tendon rupture – often associated with direct trauma or arthritis
  4. Subluxation or slipping of  extensor tendons between the knuckles associated with arthritis
  5. Ganglion cyst, or a soft-tissue mass – often presents as a small and movable nodule that is tender to palpation at the metacarpophalangeal (MCP) joint, and not as far back into the palm as Dupuytren usually is located; often seen in people younger than 50 years of age and without common risk factors for Dupuytren disease
  6. Post-traumatic or arthritic joint stiffness
  7. Sarcoma – biopsy will most likely reveal a benign etiology (e.g., lipoma, inclusion cyst).

>> Testimonials from Dupuytren Contracture Institute

>> Dupuytren surgery

The major differentiation sign between these listed conditions and Dupuytren contracture is that none of them is associated with the appearance of nodule or cord development on the palmar surface of the hand.  Based on this single point of differentiation the diagnosis of Dupuytren contracture is a fairly simple and straight forward matter.  However the diagnosis can be made more complex when the person with Dupuytren contracture also has present at the same time one or more of these other conditions.

Making the differentiation between Dupuytren contracture and other hand problems easier, the following points should be kept in mind:

  1. Typically the person with Dupuytren  disease is 50 years or older
  2. The likelihood of Dupuytren disease increases when a pitting or indentation is observed over the nodule(s) or alongside the cord(s)
  3. The likelihood of Dupuytren disease increases further when the nodule or cord formation is present bilaterally.

Early treatment of a Dupuytren contracture makes for a better outcome.  Learn more about using Alternative Medicine for Dupuytren treatment on the DCI website.

>> How to start Dupuytren treatment with Alternative Medicine

>> Dupuytren Contracture Treatment – FAQs

Dupuytren Contracture and the Proximal Interphalangeal (PIP) Joint

Dupuytren joint information is important

Potential treatment outcomes can be roughly anticipated based on Dupuytren joint involvement.  This is especially helpful when dealing with someone who has a Dupuytren diathesis and is attempting to avoid Dupuytren surgery.

There are three joints of any finger that can be affected in Dupuytren contracture, although it is the 4th (ring) and 5th (little) fingers by far that are most often involved.   When a joint is affected by Dupuytren contracture it will be kept into a gradually advancing flexed or bent posture, curled down toward the palm.  When the proximal interphalangeal joint is involved in Dupuytren’s contracture, any form of treatment is more prolonged and difficult, especially surgical treatment.

Dupuytren treatment outcome affected by joint involvement

To understand and anticipate the degree of possible difficulty while undergoing Dupuytren joint contracture treatment , it is helpful to consider which joint(s) of which finger(s) are involved. To begin, it is helpful to know that each finger has three joints or points of articulation (see diagrams, below):

Metacarpophalangeal (MCP) joint – this is the joint at the base of the finger where it joins with the palm; it is the large knuckle joint when a fist is made

Proximal interphalangeal (PIP) joint – this is the joint in the middle of finger, the one above the MCP

Distal interphalangeal (DIP) joint – this is the joint immediately below the finger nail near the end of the finger

It is important to note which joint is affected when Dupuytren contracture occurs because the prognosis and the degree of difficulty of treatment are suggested by which joint or joints are involved in the finger contracture process.

Dupuytren disease and the proximal interphalangeal (PIP) joint  

Dupuytren contracture involving only the PIP joint usually takes longer to treat successfully and sometimes requires extended treatment after initial straightening since recurrence might develop if treatment is stopped too soon.  This is especially true of the 5th or little finger.

Dupuytren contracture which affects only the MCP joint is usually the most responsive to conservative Alternative Medicine treatment methods.

When Dupuytren contracture extends to both MCP and PIP joints of the same finger it tends to statistically improve the therapeutic outlook when compared to those cases of an isolated PIP contracture.  Outcomes to aggressive Alternative Medicine treatment for Dupuytren contracture are very favorable, especially when combined with light stretching of the flexor muscles and fascia.

There is a variation of the combined contracture of the MCP and PIP joints, discussed above, that includes the DIP joint when it is bent upwards or in an extended direction.  Typically, in Dupuytren contracture the finger bending is in the direction of a downward or flexion deformity, curled toward the palm.  In this variation, called a “Boutonniere deformity,” while the usual two joints (MCP and PIP) are flexed downward, and the last joint (DIP) is extended upward.   We have observed, and confirm the finding of others who report, that the boutonniere deformity of Dupuytren’s contracture is more difficult and prolonged to treat and has a higher recurrence rate than the other finger flexion patterns.

If you wish to learn more about the non-drug and non-surgical treatment of Dupuytren contracture, especially the proximal interphalangeal or PIP joint, please click on the following links:

>> Dupuytren Contracture Treatment – FAQs

>> How to start Dupuytren treatment with Alternative Medicine

>> Testimonials from Dupuytren Contracture Institute

 

What does Dupuytren’s contracture look like?

Pictures of Dupuytren’s contracture show lumps in the palm, cords and fingers deformity   

Before displaying several Dupuytren contracture pictures it might be helpful to explain that there are two primary lesions associated with this problem.

  1. Dupuytren nodule or lump on the palm surface – This often looks like a callus on the palm or melted wax on the palm surface, usually located at the base of the 4th (ring) or 5th (pinky) fingers.  The skin is often dimpled or depressed along with a slightly raised surface, and will often appear to be a slightly darker color due to the thickening of the tissue that is taking place, similar to a callus.  As the condition progresses you will probably notice the palm lump having more clearly defined edges, deeper depressions or dimples, and thicker over time.
  2. Dupuytren cord below the palm surface – You will not directly see the cord since it is below the surface of the skin.  A cord raises the skin surface like one of the larger ligaments that you notice standing out and pushing the skin up, on the inside surface of your wrist or the bend of your elbow, when you make a fist or lift something heavy.  A cord will be found extending from the upper palm at one end to the base of the finger at the other end.  As the condition progresses you will probably notice the cord getting thicker and more pronounced over time.

In addition to the appearance of the skin related to Dupuytren’s contracture, there is also the condition of the finger flexion that is part of the visual image that is important.  As the contractures continue to thicken and shorten the involved fingers begin to flex down toward the palm.  Over time those fingers will slowly and progressively become bent, unable to straighten completely, and will be somewhat claw-like in appearance.

These Dupuytren’s disease pictures that follow should be used only for general knowledge, to compare or confirm what the reader might be experiencing, or just to see how severe the finger contracture and hand deformity can develop. In the early stages of Dupuytrens contracture everyone feels worried about the small – and sometimes large – changes in the appearance of the hand.  Not knowing about a problem and how bad it can become can be the worse part of a condition like this.

No picture of Dupuytren contracture will look exactly like what you might be experiencing.  Therefore, they are not intended to assist in making a diagnosis of Dupuytren’s contracture.  If you have not yet visited your doctor to have your hand lumps examined, allow these Dupuytren pictures to motivate you to seek prompt medical attention and a doctor’s opinion about your problem. Perhaps after studying these Dupuytren images you will feel relieved you are not so bad off in comparison to other people’s situation.

Hopefully, these Dupuytren’s pictures will be helpful to understand what this problem can look like, motivate you to get a thorough medical evaluation, and then get busy following an aggressive Alternative Medicine therapy plan to improve your changes for self-recovery to overcome your problem.  Click on Dupuytrens Treatment, to determine how to incorporate the aggressive use of multiple conservative measures to treat the fibrous thickening you might be experiencing.

Please feel free to contribute your own Dupuytren contracture pictures to DCI for inclusion on this page.

picture of Picture of Dupuytren contracture of left hand, showing well developed palm lump and pit formation with moderate ring finger flexion

 

picture of Picture of Dupuytren contracture of left hand, showing cord and advanced flexion of ring finger

 

 

 

 

 

 

 

Picture of Dupuytren lumps or nodules at base of 2nd and 3rd fingers of left hand

 

 

 

 

 

Dupuytren cord and little finger contracture of left hand, clearly defined on palmPicture of Dupuytrens, right hand with palm lump at base of pinky fingerPicture of Dupuytren lump on palm of right hand with slight flexion of middle finger

 

 

 

 

 

 

Dupuytren contracture picture, lump on palm of right hand, deep dimples and thickeningPicture of bilateral Dupuytren's contracture, clearly showing cords and riing finger contracture worse on the left hand

 

 

 

 

 

 

Dupuytren's contracture photo, left hand, well developed nodule or lump on palm and moderate finger flexionPicture of Dupuytren disease, multiple lumps on palms of both hand

 

 

 

 

 

 

 

 

 

 

What is Ledderhose disease (Plantar Fibromatosis, Morbus Ledderhose)?

Ledderhose disease treatment ideas similar to Dupuytren and Peyronie treatment

Ledderhose disease is a problem of the sole of the foot at the arch, known by several different names: Ledderhose’s disease (LD), Morbus Ledderhose, and plantar fibroma.   This condition was first described in 1897 by the German surgeon Georg Ledderhose, for whom it is named.  Regardless of what it is called, the technical description of the actual tissue pathology is a plantar fibromatosis, just like Dupuytren’s contracture and Peyronie’s disease.  Ledderhose disease occurs less frequently than Dupuytren contracture, but usually in combination with it and less so does it appear with Peyronie’s disease.

Because there is similarity with many aspects of Ledderhose disease and Dupuytren contracture and Peyronie’s disease, anyone with plantar fibromatosis or Ledderhose disease who wishes to avoid surgery, and the probability of recurrence of the problem after surgery, should consider using Alternative Medicine methods to increase the ability of the body to eliminate these plantar nodules or lumps on the bottom of the feet.   Simply go to either the Dupuytren Contracture Institute or the Peyronie’s Disease Institute websites for natural treatment information.

Fibroma is a medical term that means a non-cancerous growth or tumor composed of fibrous or connective tissue elements.

Fibromatosis is a term that describes a non-cancerous soft tissue swelling or mass that contains a large group of well developed and distinct tissue cells known as fibroblasts and collagen protein, a tendency to aggressively infiltrate normal healthy tissue and to recur within the same local area.  The fibromatosis mass of Ledderhose disease usually takes the form of one or more nodules or lumps appearing the superficial layers of the tissue on the bottom of the foot near the highest point of the arch, but occasionally can also present as a cord – just as in Dupuytren contracture, but not as often.

Ledderhose disease characteristics

The Ledderhose nodules are usually painless; as they enlarge they can cause considerable pain when pressure or rubbing is applied as when walking or standing.  Size of these nodules range from 0.5 to 3.0 cm.  The skin overlying the Ledderhose nodules tend to be moved laterally with ease, at least during the early stages of the problem.  Over time, as the condition progresses and as the nodules enlarge they are able to apply pressure to blood vessels and nerves of the foot, causing even greater pain with less walking or standing.

Both feet are involved about 20%–50% of the time, and when involvement is bilateral the extent of involvement is seldom the same in both feet.

Because Ledderhose disease likely has the same or similar genetic cause as Dupuytren’s contracture, and is thought to also be triggered the same by trauma, liver and lung disease, diabetes or chronic alcohol consumption, and stressful work that involves that part of the body.  And just like Dupuytren contracture, Ledderhose disease predominantly appears primarily in men (10:1) during the fifth decade and beyond.  Of four people with Dupuytren contracture, one will also have Ledderhose disease. Unlike Dupuytren’s contracture which affects the hands and causes progressive flexion of the involved fingers toward the palm, Ledderhose disease seldom causes flexion deformity of the toes.  As another point of differentiation, the nodules of Ledderhose are larger than in Dupuytren contracture.   Just as with Dupuytren contracture, recurrence of the lesion of Ledderhose disease is high at 50-75% five years after surgery to remove the fibrous nodules and plantar aponeurosis thickened tissue.

The absence of contracture of the toes in Ledderhose disease is explained by the way the foot is typically used on an almost constant basis to walk, stand and climb stairs; all requiring frequent and repetitive stretching of the plantar (bottom of foot) soft tissue.