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 Radiotherapy

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.

 

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