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

 

My hands got worse after Dupuytren’s surgery, what can I do?

Strategy to avoid risks of Dupuytren hand surgery   

All surgery has risks. Even the most simple and direct surgery can result in an unexpected bad reaction.  These can occur due to human error and judgment issues, or simply for reasons that are unavoidable and totally unexpected.

Complications after open hand surgery for Dupuytren contracture  (palmar fasciectomy) is variously reported to occur in 17% to 41% of cases, clearly higher than for many other types of surgery.  While the side effect and complication rate for needle aponeurotomy (palmar fasciotomy) is much lower at 2 to 4%, this must be weighed against its much faster Dupuytren recurrence rate and the need for additional palmar fasciotomy surgery sooner and more often.

It is important to understand that chances for adverse reactions after either of these two types of hand operations are at least doubled when performed as a second or third Dupuytren surgery.  Simply stated:  1. The more often palmar fasciectomy or palmar fasciotomy are performed the riskier each succeeding surgery becomes, and 2. repeat hand surgery is performed because of the high rate of recurrence of Dupuytren contracture after surgery.  With each surgery normal anatomy changes and less useable tissue remains.  Sooner or later so little tissue is left for the next surgeon to use, until no more hand surgery can be done.

Avoid or delay palmar fasciectomy surgery with Alternative Medicine

Those considering a second or third Dupuytren surgery after a needle aponeurotomy (palmar fasciotomy) or open hand surgery (palmar fasciectomy), should be interested to consider natural Dupuytren treatment as a possible way to postpone or avoid another hand surgery.

To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

Medical researchers, Loos, Messina, and Bulstrod report successful outcomes of Dupuytren treatment using massage, exercise and traction, all without surgery.  Even so, not much interest is given to their work because research funding is always focused on high profile surgery and drug therapies. Natural therapies of Alternative Medicine are not a high profit way to treat Dupuytren contracture, although the Dupuytren Contracture Institute has been providing insight and assistance since 2002 to help people deal with their hand problems.

Not all people respond well to drugs and surgery, and not everyone responds to Alternative Medicine.  And just as no one in the practice of medicine can say with certainty that any drug or surgery will be successful, no guarantee can be offered that non-drug and non-surgical natural methods will assist your recovery. Even so, the advantage of using a simple and low cost Alternative Medicine approach is that when it does successfully assist the body to recover from a health problem, the need for drugs and surgery is lowered, delayed or eliminated.   Another major advantage is the well known low risk of natural therapy compared to drugs and surgery.

For those who have never had Dupuytren surgery, the conservative option is to undergo a short therapeutic trial of care with natural remedies first – rather than last – to possibly avoid hand surgery.  For those who have had one or two Dupuytren operations, the conservative option is still open but with reduced expectation.  In these cases the body has less normal tissue to work with; results cannot be as good as when surgery was never performed.

In the experience of the Dupuytren Contracture Institute working with those who have had one hand operation, it is possible to eliminate the need for a second surgery and cause doctors to change their recommendation for the need of a second surgery.  With a brief trial of Alternative Medicine treatment it is possible to make positive tissue change and either avoid or delay the need for surgery.

Rapid recurrence of Dupuytren contracture means more hand surgery later

Many who write on Dupuytren’s forums express the cavalier notion that they are willing to submit to needle aponeurotomy every few years even though recurrence is more rapid with this type of less invasive hand surgery.  They explain that they prefer NA because recovery is so rapid or they can use their hands in a few days with no rehabilitation. They fail to calculate that this does not necessarily happen each time needle aponeurotomy is done. They do not consider the risk of an adverse reaction increases with each surgery, preventing this approach to be used indefinitely.

For those who already have had one Dupuytren’s hand surgery and want to avoid another, this article presents possible avoidance options as well as the potential complications and risks of palmar fasciectomy, also known as Dupuytren’s contracture open hand surgery.

Bad reaction after Dupuytren’s surgery, what is next?

The idea that it is possible to correct a bad surgery with another surgery must be examined very closely.  While there must be cases where this works out well for the patient, extreme caution must be used to assure a bad situation is not made worse by additional irreversible tissue changes of compounded surgery.

First, get a second surgical opinion but not for the reason many people think. Patients typically approach a second medical opinion only to see if it agrees with the first.  This is often just another way of allowing two doctors to make a decision for a patient. The best use of a second doctor’s opinion is to receive additional medical information and a different view point to round out the thinking of the patient.  Both medical opinions should supply information to help the patient decide the next step to take.  It is the patient who must ultimately decide the best course of action to take to return to health.  When the patient does not feel capable of making that kind of decision, it is the fault of the doctor who has not provided adequate information to the patient.  Find another doctor who will talk to you and explain things in such a way that you can make this decision!

In no way is it suggested that a layperson can know more about the practice of medicine than the doctor.  Even so, the layperson must ask questions and receive answers from at least two doctors so she is able to make an informed and intelligent decision about her care – not the doctor.  A lazy patient does not get the best care.

It is the responsibility of the patient to assure that a second surgery is the best step to take – as it might be. Too often patients rely solely on the judgment of the first doctor they encounter to make important decisions for them.  This is not wise.

If you do not like the thought of additional Dupuytren surgery, for whatever reason, you can consider attempting Alternative Medicine treatment for a month or two or more to learn if your body is capable of reversing the abnormal hand contracture.  If it helps your situation and surgery is no longer indicated, look what you have gained.  If it does not help, you can have surgery knowing you have not been hasty, you have used conservative measures appropriately, and whatever reaction occurs from a second surgery was indeed unavoidable because less aggressive measures did not help you.

Suggestions to determine if your body is capable of changing the soft tissue contractures in the palm and fingers:

1. Learn about your Dupuytren problem from a different standpoint.  You were told you needed hand surgery by the MD who gave you the diagnosis of Dupuytren contracture.  Almost all internet information about Dupuytrens promotes surgery.  Go to the home page of the Dupuytren Contracture Institute for holistic information about day-to-day treatment. The information found on this website is unique because we present the idea that not all Dupuytrens needs surgery.

2.  Determine the most aggressive Dupuytren therapy plan you are comfortable following.  For best results do all that you can to help yourself.  Consider using what is called the “Large (Best) Plan” for personal treatment.  The “Medium (Better) Plan” is the most popular of the DCI plans.  The “Small (Good) Plan” is also well designed.  These three plans are found at the top of the page at Dupuytren treatment plans.   Any plan can be modified by subtracting or adding to suit your personal Dupuytren contracture treatment philosophy.  These plans are only examples of how to approach this problem, and have helped hundreds of people over the years.

3. Stop feeling discouraged. Read the Dupuytren Hand Bump Forum.  Get educated, motivated, and reminded that everyday around the world there are people who are actually beating their Dupuytren problem following the Alternative Medicine methods of the Dupuytren Contracture Institute.

Complications of open hand Dupuytren surgery (palmar fasciectomy)

No one, not even a surgeon, can predict the side effects and complications of a particular surgery – and that is the problem.  While many patients, even a majority, receive a palmar fasciectomy without an adverse reaction and no post-surgical complication at all, there are those who are worse after surgery.  The number or percent of adverse surgical cases is not important if you are one of the unlucky patients whose outcome is poor. The only bad outcome that matters is your own.

Keith Denkler, MD, in 2010 wrote, “Surgical Complications Associated with Fasciectomy for Dupuytren’s Disease: A 20-Year Review of the English Literature.”   His final comments,
“In conclusion, results of this study underscore the importance of
treating Dupuytren’s as an incurable genetic disease understanding that
surgical excision, fasciectomy, has a high rate of major and minor
complications. Surgeons must understand that while fasciectomy for
Dupuytren’s does offer a chance at long-term ‘straight’ fingers, there is
a high cost in terms of numbers of complications that are borne by the
patient.”

Because the hand is a highly complex and densely packed machine with practically no space separating very delicate nerves, blood vessels, muscles, ligaments, tendons, and fascia, the patient must carefully select the best surgeon for the best hand operation outcome.

The Dupuytren Contracture Institute is not against hand surgery.  DCI only suggests it is a prudent step to first try Alternative Medicine to learn if their Dupuytren soft tissue problem is partially or completely reversible, thus making surgery unnecessary.  If the need for Dupuytren hand surgery remains after natural methods has been unsuccessful, find the best surgeon possible.

How do I make my Dupuytren treatment plan better?

Hi Doctor,

Thank you for this very helpful website.   All of the others give the same old surgical pitch, but this is the only one that seems to put the whole idea together that makes sense to me.

After 5-1/2 weeks following the plan you see below I definitely feel my fingers are more flexible and I can flatten my hand down on the table about 3/4 of an inch more than I could for the last 4 years.

I take

Integral E 400/400 – 2/day with meals
Maxi-Gamma E – 1/day with meals
MSM – 6/day between meals
Quercetin-bromelain – 4/day between meals
PABA – 6/day with meals
Scar-X – 2/day between meals
Neprinol – 6/day between meals
Acetyl-L-carnitine – 2/day with meals
Fibrozym – 4/day between meals

Almost six years ago I had hand surgery and it was the biggest mistake of my life.  I had a beautiful recovery with no problems, my incisions healed in record time, and I flew through PT without a problem.  All that time I kept asking my doctor and my therapist why I lost feeling in my fingers, and they kept telling me my feeling would come back real soon, but it never did.  On top of that, my palm lumps came back in about 11 months and they were  worse than before, and I can predict the weather because of the hand pain I have now that I did not have before.

After having the Dupuytren surgery my doctor said would take care of my hand, I have a worse case of Dupuytrens, and a bunch of new problems.  Since then I learned from the DCI website and a DC forum I read that the palm nodule s and cords always come back. Sometimes they come back in a year or two, or in five years but they always eventually return.  My doctor never said a word about that to me. All he kept saying was that he was going to remove the lumps and I would be able to move my fingers again.  He was correct for about nine months and then i was back to square one.

Your treatment ideas are the first ray of hope I have had in almost six years, but I want to do better. How do I make my Dupuytren treatment plan better?

HCF – Ohio

Greetings HCF from Ohio,

It makes me feel so good to know you have finally gotten some help with your Dupuytren contracture, especially after such a bad result from your hand surgery.   Your kind of poor results with nerve damage causing numbness and pain is a lot more common than you would imagine.

Most people have recurrence of their Dupuytren nodules and cords after surgery and some as quickly as within the year after their operation, just as you experienced.  This is the way that Dupuytrens commonly reacts – it comes back even when you think it was all completely removed after having surgery to correct the problem.  But the real kicker is that so few surgeons tell their patients about Dupuytren contracture recurrence after surgery ahead of time, and then they act like it is something unusual and strange about the patient when it returns.  The reality is that surgeons do not like to tell patients ahead of time that the Dupuytren nodules and cords will return in a few years because of fear the patient would back out of surgery and the doctor would lose income.   And they also do not tell their patients that when the Dupuytrens returns it will probably be worse than the original problem.

Anyway, congratulations about making such nice headway with your problem, and congratulations on having such high hopes and optimism that you can continue to recover use of your hand.  That really is great and I applaud you.

What is wrong with your current plan – as effective as it might be for you – is that it consists only of internal therapies (vitamin E, MSM, acetyl-L-carnitine, etc.). What I mean is that you are only popping a lot of vitamin pills, and you should be doing some other external therapies to balance and broaden your treatment approach. While it is always a good idea to use as many  internal therapies as you think are needed and appropriate for your case, these system-wide internal therapies will work better when combined with external therapies.

External therapies that can be used for Dupuytren contracture are:

  1. Dusa Sal DMSO
  2. Super CP Serum
  3. Unique-E Vitamin E Oil
  4. Genesen acupuncture therapy
  5. Moist heat application

All of these eternal products are available on the DCI site at DCI treatment store Since you are doing well with your current plan, please do not become overconfident that it is able to sustain a complete recovery.  And do not make the mistake of just swallowing a lot of pills, thinking you are doing a good job of treating your Dupuytren contracture.  Good treatment is a balance of internal and external therapies.

Please consider adding in a few of these external therapies and I suspect you will see a further surge of improvement in your hand situation.

Please let me know if I can help you as you go through your therapy.  TRH

Is forceful stretching and finger straightening harmful to Dupuytren contacture?

Dear Dr Herazy,
Thanks for your website, I find it to be a helpful and positive source of interesting information.  I have a couple of questions if you have time.
I was diagnosed with Dupuytren hand contracture early this year. At that time both hands hand small lumps and had some pain.  In the last week I noticed the right hand is getting worse faster and the little finger and ring finger are not as easy to straighten.
I’m doing two things at the moment, deep rubbing and stretching the lumps on my palms and forcing my fingers straight, and applying Vit E ointment. Are there any problems doing this, and what more can i do to help myself?

Regards
Andrew

 

Greetings Andrew,

Yes, there could be a huge problem with what you are doing.  Please stop doing that aggressive rubbing and stretching of the palm lumps, and do not forcefully stretch or straighten your fingers.  This is not a good way to treat your Dupuytren problem.  Applying vitamin E by itself to the palm of hand over the nodules and Dupuytren cords is not very effective.  When vitamin E is applied without DMSO to drive it into the tissue the vitamin E oil will not get in deep enough to benefit you.  While it might not harm you, it is not doing you much good as you are applying the vitamin E incorrectly.

I know you might think it makes sense to forcefully reverse and straighten your bent fingers, but you could be easily hurting yourself.  By aggressively reversing the flexed finger position it is possible to over-stretch, irritate, tear and even rupture the tendon sheaths related to the fingers that are involved in your Dupuytren contracture.   You could injure yourself by trying to force the deep palmar soft tissue to do things it is not ready or capable of doing at this time. These things take time to be done correctly.

To work with the deep and superficial soft tissue of your hands requires a special technique that will get the job done and at the same time avoid injury.  It is now mid-2011 and I am about half way finished working on a book that will explain the safe and effective way of doing soft tissue work on your Dupuytren contracture without injuring yourself.   Please look for the book in early 2012, titled, “Dupuytren Contracture Handbook.”

Rubbing vitamin E oil by itself is not very effective, and used without DMSO to drive it into the tissue is not getting in deep enough to benefit you.  Please read the website page about DMSO to learn why you should not use vitamin E alone to treat your palm lumps.

Please spend some time reading whatever interests you on the Dupuytren Contracture Institute website.  Learn how to conduct a safe and effective Alternative Medicine treatment plan for Dupuytren contracture.

TRH

Dupuytrens Surgery Did Not Go Well

Dupuytrens contracture surgery did not go well

I have already had surgery for dupuytrens contracture in my left palm. The surgery was not well-performed and my little finger is again bending at 45 degrees. I suspect some of the dupuytrens cords were left in my finger and palm as it looks to me as if the cord is reforming in my palm. I am 57.

Would any of the supplements on the site be of any use at this stage?  If so, which would be the best to buy and what would the dosage be?

thanks
Lisa


Greetings Lisa,

Sorry to learn of your problem.

It would have helped a bit if you would have mentioned how long ago your Dupuytren surgery took place, however I think I can still offer a meaningful reply to you.

To answer you well, a few things come to mind:

1.  All Dupuytren contracture will eventually recur after surgery.   Sooner or later the hand nodules and cords will develop again.  lThe fact that your little finger is again flexing in toward your palm does not necessarily mean that your surgeon did a bad job; your surgeon could have in fact done a spectacular job, and your Dupuytren problem would return anyway, given enough time.  It is said that for about half of the patients who have Dupuytren contracture surgery the palm lumps and nodules and finger contractures will return in approximately five years or so — for some people it might be a year or two, and for others it might be ten years, but five years is an average time for recurrence after any Dupuytren surgery.

2.  You wrote: “The surgery was not well-performed and my little finger is again bending…”   Do you mean that there were other issues and problems that told you right after surgery that your surgery was not performed well, or are you assuming that because your contracture is recurring that the surgery was not performed well?

3.  The recurrence of the Dupuytrens is not due to “…some of the dupuytrens cords [being] left in my finger and palm…”   Dupuytrens is not like a cancer that must be completely removed, or it will spread.  If all of the cord material was removed, or if some was left behind, you would have had this recurrence after a few years.

4.  From my experience, most surgeons tend to underplay or intentionally “forget” to mention certain things about a proposed surgery that might discourage a patient to have that surgery.  What would have happened if your surgeon had said something like this to you before your surgery?:  “You know, Lisa, we are going to cut here and cut there on your hand and finger, it will hurt pretty bad for a week after the surgery, and you will have to do rehabilitation for a month or two that will also be rather painful.  As a result of this hand surgery there is a good chance you will lose a little bit of feeling in your fingertip and you will also find that you will not get back full use of your finger because it will be permanently just a little stiff, and you will be able to predict bad weather in the future.  And, oh, one last thing:   I will do the best job for you that I can, but no matter how good I do, your Dupuytren contracture will come back in about five years — give or take a few years.  Actually, once I start doing Dupuytren surgery on you, I will have to keep on doing them because the condition never really goes away.”  You might not have had that surgery.  And that would mean your surgeon would have been a little less busy that week.

5.  There is not any way I or anyone can tell you ahead of time which of the DCI therapies may, or may not, be successful for you.  These are not drugs we are dealing with.  We are attempting to use naturally occurring nutritional substances to stimulate and support your ability to heal and repair the Dupuytren contracture and related soft tissue reaction in your hand.   Further, there is no best one to use.  They are all important and effective in their own way and all contribute to your effort to recover from the Dupuytren contracture.  What makes the DCI approach different and more effective than other Alternative Medicine approaches is that we recommend that you combine several therapies at the same time to “gang up” on your hand problem and support your healing potential to the maximum of your ability.   To understand this better I suggest that you read Dupuytren Contracture Treatment Philosophy and Dupuytren Contracture Treatment and Alternative Medicine.

6.  Dosage is always an important question.  Dosage is started at the lower end of what is suggested on the label of each therapy product.  From there it is increased in a way and at a rate that is thoroughly explained in the literature that is sent to you with each order you receive. You will be given complete instructions and suggestions to increase your dosage and manage your treatment in a way that will lead you to the highest level of recovery that is within your potential to heal and repair.