Is my hand problem a cyst or Dupuytren contracture?

dear dr. herazy, 

my name is mark c, and  i have a question concerning my hands.  on my left hand, immediately under my ring finger, it look’s like i have a cyst! very hard to open my hand fully. in the middle of the hand i see something like a tendon sticking out and it appears to be  connected to the cyst. i also have a little one starting on my left hand. i can’t fully extend my left hand flat out because of the cyst.  i have heard there are alternative procedures for my ailment, like cortisone shots, etc. i do not know if i have a cyst or dupuytrens.

thank you for your time,

 mark c.

 

Greetings Mark C,

Thank you for writing to ask about the problem with your hand.

Based on the way you describe your hand problem, and the fact that you did not say so, I will assume that you have not seen a doctor at this time for the problem you are having with your hand.  This is a mistake.  You should see a doctor in your area about your hand so you will know exactly what the problem is that is causing your complaints.

Further, since you are having a problem of a mass located near the base of your ring finger and trouble flattening your hand and cannot open your hand fully, along with the appearance of what looks like a tendon connected to the palm lump, your description does make it sound like you have Dupuytren’s contracture.   

If it turns out that you do have Dupuytren’s contracture it would be helpful to determine if you can increase the ability of your body to remove the dense fibrous tissue that is developing in both of your hands by using Alternative Medicine methods as are outlined on the DCI website.  Many people find improvement after aggressively following a plan of treatment for a few months of self-administered care.   If after this time you do not see improvement in your problem then you can always consult with a surgeon to discuss hand surgery, although Dupuytren surgery is always eventually followed by recurrence of the same problem – usually within a few years.

Once you know the exact cause of the problem you will know how to proceed.    TRH

Does this sound like Dupuytrens contracture to you?

I was told i have Dupuytren’s contracture but i have my doubts. Symptoms of a very very painful middle finger in my non-dominant hand. If i touched or banged it, it could bring me to my knees. After the major acute pain stopped i had burning and tingling back of hand and palm side of finger. My finger curves and i can only straighten it manually. The finger triggers if i suddenly grab for something. It hurts like hell and i have to manually snap the finger up. It does not bend down at the proximal palm joint like most pictures show. the finger is swollen. made worse by weight gain. Now my right middle finger is starting to bother me although not as painful. My thumbs trigger though getting better, my right thumb has limited range of motion, and my left ring finger triggered in past. I cannot bend my middle fingers past 90 deg from proximal or middle knuckle making it difficult to grasp, open jars etc. I manually straighten my fingers daily. Diet does seem to make a difference, i have cut out sugar and wheat, salt, restaurant food aggravates.

I work full time at a job where i use computer. my other job is as a massage therapist, (no brainer, this is a lot of hand use). I am able to compensate to do massage and typing accentuates the curve as does driving (no power steering). I think i am going to start your dietary supplements but i still doubt the DC diagnosis… sorry this is so long trying to be clear and thorough. Does it sound like Dupuytrens contracture to you?

I have on one or two occasions i have  felt tightening in my foot and my wrists and forearm tendons seem to be involved. I can see the tendon in the hand is prominent, but no nodules. The finger bones close to the palm are sore. Upon manual manipulation i can feel popping in the middle phalanx joints of the affected fingers.I was diagnosed by a neurologist as having a slight nerve problem in the left forearm between the bones…interosseous nerve syndrome? I think, it is not very common. He is very good but didn’t see this as a nerve issue.

I am of Scandinavian descent, my father did have a contracture after breaking his hand in a jackhammer accident.

ANY ides, brief or otherwise would be helpful. I live in Hawaii and it is like a rural community. Very informed. Specialists are not the norm.

If needed i will call for a paid consult and can send pictures of my hand. I’m so happy to have found this site after a year of no meaningful information.

Thank you sincerely, Aloha, Dawn Matney

 

Aloha to you Dawn,

Thank you for the detailed description of your problem with finger and hand pain, and for the complement. My intention with the Dupuytren’s Contracture Institute is to offer meaningful information and suggestions while under the limited circumstance of not being able to see and examine the problems for which people need help. As  you can imagine I am only able to offer an educated guess as to what is going on with your hand problem.Ultimately you have to decide what is the truth of your situation and if you feel it is appropriate to seek out another opinion for a diagnosis and treatment.

Based solely on the description you offer, your problem does not sound as much like Dupuytren’s contracture.  My impression is that it is more likely an inflammation of the palmar tendon sheaths due to the trauma of extended overuse. 

Using your hands rather continuously as you do now between full time work with a computer plus massage therapy is more than your hands can tolerate.   In that last sentence I would like for you to consider the operative phrase, “as you do now.”   What I am suggesting to you is that you evaluate exactly how you are typing on the keyboard and the way you use your arms and hands for body work. I suspect that you are using bad habits that are stressing your shoulders, arms forearms and hands, and this is the cause of most – if not all of your current hand pain.  I tend to be far too aggressive when I type; by the end of the day, if I have not controlled my hand action, I can make the tips of my fingers sore to the touch.  You too are probably not working to your best mechanical advantage.  Observe yourself while at work and see what you can do differently, or not at all, that might help your situation.              

While trigger finger and pain are sometimes a component of Dupuytren’s contracture, no the primary problem as you have presented your current situation.  Also, while you are of Scandinavian descent (and hereditary factors favor those of Scandinavian descent for Dupuytren’s contracture) you made your father’s hand problem sound more like a hand problem that arose from one particular work accident, so my impression is that you probably do not have DC in your immediate family history.  You do not report a palm nodule nor cords and these are almost mandatory to establish a diagnosis of Dupuytrens.   Lastly, you report that your diet seems to make an impact on your hand symptoms; this would not likely be true for a pure Dupuytren problem.  Put all these things together  and to me it does add up as a case of Dupuytren’s contracture.

I suggest that you look around your island to see if there is a good chiropractor or naturopath who can work with you from a dietary, structural and soft tissue basis to control and eliminate your upper extremity problem. 

Are these several health problems and surgery related to Dupuytren’s contracture?

Doctor,

I was recently diagnosed with Dupuytrens on my right hand, VERY mild.  A year later, I had a pyogenic granuloma on my left second toe. It was removed a month ago. A few weeks after it was removed I noticed a lump on the arch of my foot seemingly attached to the tendon that attaches to my big toe. It does not hurt and is soft and moveable (for now). It is sounding like it may be Ledderhose disease since one in 4 people that have dupuytrens also gets Ledderhose? My right shoulder also suddenly started hurting and my doctor thought it was an injury from exercise but now I am wondering if the pyogenic granuloma, dupuytrens, growth on arch, shoulder pain are all related somehow signifying that something else is going on in my body. Most Doctors tend to treat each separate but I read where dupuytrens may signify some sort of liver or lung problem. I want to cure these things naturally and do NOT want the recommended radiation for the Ledderhose nor do I want to have this foot growth enlarge causing pain when walking. It does not hurt now. Do you know if these are all related or perhaps something else is going on in my body I should convince a doctor to pursue?

Thank you for your help.

 

Greetings,

Without getting into a lot of the details, pyogenic granulomas are small, red/pink to purple  bumps on the skin that bleed easily due to an abnormally high number of blood vessels they each contain.  The name pyogenic granuloma is misleading for two reasons:  It is not a true granuloma, but it is actually a capillary hemangioma.  And it is not infectious as the pyogenic part of the name would indicate since the origin is typically hormonal or traumatic.  What concerns me about your story is the fact that pyogenic granulomas are almost always found on the top half of the body (75% occur int he mouth) and most often in pregnant woman (they are sometimes called pregnancy granulomas) as well as in children or younger adults.  If this is not the case with you, I strongly suggest that you get a second opinion if there is any other irregularity about your health or extremities in general that arises to give you concern.

Many times I encounter people whose Dupuytren contracture starts after some type of trauma– not only trauma to the hand as you would naturally assume, but to trauma elsewhere in the body.  It is almost as though the trauma (like the trauma of surgery) somehow triggers a latent tendency for excessive fibrosis to occur elsewhere in the body as with Dupuytren’s contracture in the hand or Ledderhose disease in the foot.

Yes, Dupuytrens and Ledderhose often occur together in those who are genetically predisposed.

If you have to convince your doctor to purse a course of action or investigate your problem further, you have the wrong doctor.   Medical doctors by their training and personalities as a group tend to be “team players” and to not think outside of the box. Please.  I am not saying that MDs do not think; I am saying that they think within a narrow and pre-defined range of information that has been approved for them to use.  Anyone who is a medical doctor and prefers or needs to think independently, or to use innovation, will go into research.  Those MDs who are comfortable doing what they are told and following the narrow paradigm of how the AMA, FDA, hospital review boards tell them they MUST practice, will go into practice where they will work like everyone else in their profession. This is why when you go to four different MDs with a problem they will all want to do the same tests and they will want to know what the other MDs said about the problem, and will come to pretty much the same conclusion.  Organized medicine does not want and cannot afford to have MDs going out on their own and experimenting with patients; they must interpret test results as they are told to do by their peers and regulators; they must use drugs only as they are allowed and told to do; they must not operate in new and novel ways.  To put it another way, an MD will get into trouble if he or she does independent thinking and digs too deeply into the practice of medicine and the healing arts beyond what is given to him or her as the standards of practice.  This is why some MDs get so frustrated and discouraged with the practice of medicine; this is why a few will either eventually quit or go radical by engaging in “holistic health care” in which they declare themselves independent and rather radical in their approach to healthcare.    

Ask your average MD,Do you know if these different things – Dupuytren’s contracture, pyogenic granuloma, surgical removal of pyogenic granuloma, Ledderhose disease are all related or perhaps is there something else is going on in my body”?   By his or her education, training and personality characteristics he or she will not do much if any independent thinking, but will only say something like,  “I have not read anything like that.  And the research says that it is not possible.  So therefore I do not have any information for you about that.”  MDs work with information that has been given to them by others.  If an idea is not an approved idea they are not comfortable with it, and they are safest not using it and actually ridiculing it. This is the only safe answer that the average MD can use to practice medicine because they all know that if they think or act independently they can get into trouble. Heck, they have hospital committees watching what they do, how they test, how they diagnose, how they prescribe, how they operate, and what kind of results they get.  If they practice outside the standards of medicine they have a whole lotta explaining to do.  No one wants trouble,eh?

Since I am not an MD, but a retired Chiropractic Physician, who has thought independently all of my professional life, I will say that my experience says there is something to what you have observed.  It suggests to me a weakness or irregularity of the immune response perhaps related to a systemic allergic reaction.  My recommendation is that if you see larger health issues at play in your life that you should seek out a local holistic MD who will look at you with a different set of eyes and ears than the garden variety MD possesses.

In the meantime I also suggest that you read a bit more from the DCI website about the use of Alternative Medicine to support and enhance your natural ability to reverse the soft tissue changes of Dupuytren’s contracture.  Many people have slowed down, or reduced, or even eliminated their Dupuytrens this way when it is done as described here using an aggressive and faithful treatment approach of several months care.

Please let me know if I can do anything more to assist you.  TRH

Is it normal to have numb fingers after Dupuytren hand surgery?

hi doctor.
i had a fasciectomy 8 days ago for dupuytrens, yesterday i returned to hospital for re-dressing and hand clinic. When i returned home i felt my little finger and it was slightly numb around the tip and nail. i had not noticed this the previous week due to the dressing and splint holding my little, and ring fingers up. i’m just now wondering is this normal after that type of surgery and is it likely to return to normal. thank you
p.s i’m 31 years old

 

Greetings,

Palmar fasciectomy for Dupuytren’s contracture is typically a rather extensive and difficult  surgery; all hand surgery is complex because of the nature of hand anatomy.   Hand surgery is complex because the hand is such a tightly packed area in which muscles, tendons, ligaments, nerves, blood vessels – and of course fascia are extremely close together with no open spaces or extra room in which to maneuver.   This complexity is better understood when you consider that in Dupuytren hand surgery there is foreign tissue in the handthe internal Dupuytren cordswhich are not supposed to be in the palm of the hand.  This extra tissue crowds into an already crowded part of the body.   Thus, a hand surgeon is faced with an especially complex and difficult task when she enters into such a situation.

A certain degree of temporary numbness and pain is to be expected after such a operation like a palmar fasciectomy.  A lot of delicate tissue was cut up, handled, stretched and probed, moved around, sewn up and altered in ways that the tissue have never experienced before.  Any numbness is understandable because delicate nerve tissue was traumatized in surgery, but these ares of numbness should pass in time; perhaps a month or two or more.  There is also the possibility that all or a portion of the numbness that you now have will remain.  The numbness might even increase because of tissue changes within the palm that might take place over the next several months as the hand heals after surgery; there is always a possibility that internal scar tissue will develop that can apply pressure or traction on nerves that could result in more numbness or even pain.  Anything is possible.   

It is unfortunate that you have not had any of this explained to you by your surgeon, for two reasons.  First, this would be especially true if your doctor knows you had a relatively easy and uneventful hand operation and it should have been explained that any numbness would be temporary and limited, so that you would not worry unnecessarily as you are now doing.  Or, second,  perhaps if the surgeon knew you had a relatively difficult and nasty hand operation.  It should have been explained to you that permanent numbness was unavoidable under the circumstances, so you would be prepared for the future – as you are not now prepared because apparently none of this was discussed with you.

Assuming that you surgeon is not a good communicator, I will further assume that something very important was also not explained to you.  Allow me to caution you that palmar fasciectomy is never a permanent correction or solution for Dupuytren’s contracture.  After any kind of Dupuytren’s surgery there is a tendency for the hand problem to recur; some types of Dupuytrens hand surgery have a faster recurrence rate than others, but they all are plagued by recurrence eventually.  You did not mention the type of of palmar fasciectomy you had, but for example in a partial palmar fasciectomy the recurrence rate is 66% in five years.   This means that after a palmar fasciectomy 2/3 or 66% of those patients will have recurrence by the 5th year.  What about the other 1/3 or 34% who do not have recurrence by year five?  They will likely have a recurrence in the 6th, 7th, 11th or later year, but it will recur.

This  Dupuytrens contracture recurrence after hand surgery is the reason why you will hear of so many people who have more than one had surgery on the same hand.

This number does not express the fact that of the 66% whose Dupuytren problem comes back within five years, not all of those patients have the recurrence happen in the 5th year; some have recurrence in the 4th, 3nd or 2nd year, and some even in the first year.  

You might say to yourself that this is a risk you are willing to take because you might be one of the lucky ones who does not have Dupuytrens recurrence until the 10th year or later after the palmar fasciectomy.  Yes, this is possible and perhaps you are willing to take that risk.  But, it is also true that after having the first hand surgery, the recurrence rate increases or gets faster for the second and all succeeding surgeries.   This means that  after developing a recurrence of Dupuytren’s contracture, in two years or 12 years or whatever,  if you choose to have a second palmar fasciectomy the recurrence rate will be sooner or faster than it was after the first hand surgery.   Further, if you have a third recurrence and have another hand surgery the recurrence rate will be even faster than after the second surgery.   Some patients who have a fast recurrence rate after the first surgery get into trouble rather quickly.

At age 31, as young as you are, you have many long and wonderful years ahead of you.  Because you have a lot of time to eventually have a recurrence of Dupuytren’s contracture, I caution you to take especially good care of both hands, do everything  you possibly can to keep your hands healthy and to do all that you can to avoid that second hand surgery.

The Dupuytren’s Contracture Institute is devoted to the non-surgical and non-drug treatment of this terrible hand problem.  It might be of interest and treat value to you to spend some time reading about the Alternative Medicine method we have researched to assist the self-repair of Dupuytren’s contracture.

Any success with home ultrasound treatment for Dupuytren’s contracture?

Have you heard of any success with home ultrasound devices for Dupuytren contracture? If so , please give details ie: how long; how often etc.
thank you.
RRG

Greetings RRG,

Over the years I have communicated with several people about their use of small ultrasound equipment for treatment of Dupuytren’s contracture, but never with positive results.  TRH