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.

Is this lump in my palm anything to worry about?

Lump on palm of hand should be investigated

As a general rule, anytime you discover something new happening to your body you should be concerned enough to quickly determine if the new situation has important short- and long-term consequences.   In the case of a bump, nodule or lump on the palm of the hand that appears without reason, it could be important and should not be dismissed.

Of course, the first explanation for a palm lump or nodule is that it could be a simple callus.  If a callus makes sense based on new or greater manual work you have been doing recently, especially without the protection of gloves, then that is probably all the concern that is necessary.

However, if you have not been using your hands more than usual lately, then you should do a quick mental inventory of any other recent symptoms you have noted about your hand:

  • Can’t extend or straighten one or more fingers
  • Can’t open hand completely
  • Can’t lay palm flat down on a table top
  • Fingers won’t open up after being used
  • Fingers won’t straighten
  • Fingers are restricted in full movement
  • Fingers curling in toward palm
  • Pinky finger or ring finger won’t extend fully
  • Lump, bump or nodule on the palm of the hand
  • Can’t open hands without pain
  • Stinging or burning pain in hand
  • Feels like a swollen tendon in the palm of hand
  • Feels like hand constricting and won’t open easily

If you note one or more symptoms that reduce your ability to use your hand and fingers, then you could have a fairly common condition known as Dupuytren contracture.

Lump in palm of hand common Dupuytren contracture finding

Dupuytren contracture is a problem of the soft tissue characterized by thickening and shortening of fibrous bands located in the deep tissue of the palm of the hand (palmar fascia), caused by an excess amount of a tissue protein called collagen.  As this progresses a cord of tissue will develop below the surface or a lump in the palm on the surface, resulting in reduced mobility and contracture of the hand and finger.  This involvement can affect one or both hands, and a variable number of fingers.  Dupuytren contracture presents in a wide variation, from a mild and slowly progressing contracture of a single finger, to severe and rapidly progressive involvement of several fingers of both hands, or many variations in between.

Alternative medicine treatment when combined into an aggressive assembly of natural therapies (vitamin E, PABA, acetyl-L-carnitine, massage, stretching, copper peptides, systemic enzymes, etc.) are often effective in reducing or eliminating the excess collagen cord or nodule formation and the subsequent finger contracture that so often prevents the 4th and 5th finger from being able to extend or open fully and keeps the involved fingers curled in toward the palm.   For information about using natural treatment methods to treat Dupuytren’s contracture, and to possibly avoid the need for Dupuytren release surgery, click natural Dupuytren Treatment Plan.

One or more dimpled and thickened bumps on the palm are most often caused by Dupuytren’s contracture.  This is especially true for any unusual small nodule or lump on the hand that appears on the palm at the base of the 4th (ring) or 5th (pinky) fingers, especially if the involved finger or fingers won’t completely straighten out.  Although it is always advisable to get a medical diagnosis of this kind of health problem, it is possible to develop a strong suspicion the problem is Dupuytren disease if several indicators and factors are present in your history:

  • Ancestors who came from England, Ireland, Scotland, Wales, or a Scandinavian country
  • One or more family members also have Dupuytren contracture
  • Palm lump located immediately at the base of the ring and/or pinky finger
  • Age 45 plus
  • Male
  • History of manual labor doing heavy or repetitive work, often with hands unprotected
  • History of tobacco smoking
  • Diabetes
  • Alcohol abuse or liver disease
  • Epilepsy

Dupuytren contracture will often return or recur within a few years after surgery that releases the finger contracture by removing the cords or lumps on the palm.  In fact, some forms of Dupuytren surgery have am 80% recurrence rate 3-5 years after the first operation, and even faster recurrence for a 2nd or 3rd surgery.  Hand surgery should not be seen as a solution or cure for Dupuytren’s contracture since recurrence is such a common problem not only for hand surgeons, but also the patients they serve.

Many surgeons voice the opinion that in many cases Dupuytren hand surgery seems to accelerate and worsen the development of cords and lumps on the palm.  For this reason it is suggested that a person who has Dupuytren cords and lumps should first attempt a therapeutic trial of aggressive Alternative Medicine to determine if the body is capable of reversing or even eliminating the tissue changes that makes the fingers curl in toward the palm and prevents the hand from opening completely. If after two or three months of natural treatment no change is seen, Dupuytren surgery can always be done at a later time.

Natural alternative therapies such as suggested by the Dupuytren Contracture Institute do not receive evidence-based research because of their limited profit potential and easy access by laypeople, and so have little support from the medical profession.  Even so, with a little independent research on this website it should be obvious that these natural healing ideas make sense and do not interfere with subsequent medical treatment.

 

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

 

 

Tell Us About Your DC Problem.