Who has DUPUYTREN’S CONTRACTURE?
 

Looks like I have what my Dadz had. Should have listened closer to what he did as it is obviously hereditary. I usually sleep with my hands flat under a pillow and head on top.
The pain wakes me up and I have to shift to hands to my sides and semi clenched to get back to sleep.

My right hand is the worst. Three pretty good sized knots under my second and middle fingers. Minor resistance to straightening my fingers. Medicaid kicks in at 16 months.

What should I expect? Are the Doctors advertising non surgical treatment FOS?

Nothing to do for now. There's nothing you can do now to change the course. Only if you start developing flexion contractures is it worthwhile to intervene. Then you can decide if you want surgery, an office needle procedure, or an injection.

OK, I know it's not life threatening.....what about straightening the fingers and having them lock in a double jointed/flextion? Same hand same fingers. Also something new.....

I live with a similar condition due to my spinal injury, but mine is caused by nerve damage resulting in severe muscle spasticity. My right hand exists in a perpetual claw and I'm unable to straighten my fingers. I feel for you.

JB: Are you sure you have Dupuytren's? Dupuytren's is usually not painful. With Dupuytren's you'll get firm nodules under the skin in the palm. With time, they may start to form cords of connective tissue that extends into the fingers (again, all along the palm side). Only if the cords start to contract and flex the fingers (usually the ring, but can also be the small finger or sometimes middle finger--rarely the index finger or thumb) down into the palm do you intervene. But if you start to get flexion contractures, it's not something you can "fight." You can't straighten back out your fingers, short of some medical intervention. Again, Dupuytren's is rarely painful.

But if you're having pain, and you feel like the fingers are locking in a flexed position (but you can sometimes straighten them back out), then it sounds like you may have trigger finger. That's totally different. Then you're looking at cortisone/steroid injection or possibly definitive surgery (if you try and fail a cortisone injection). That's a lot easier and more satisfying to treat.

http://forums.pelicanparts.com/uploa...1616177794.JPG
Is this what you're talking about Noah?

That looks more like a popliteal cyst.

I believe a friend mentioned an ultrasonic device helped.

Look Mom, no hair! But I still need glasses.

http://forums.pelicanparts.com/uploa...1616182420.jpg

That's Dupuytren's. Mine is 10 times that bad. It can get into your foot arch as well. First thing the hand doc did after looking at my hands was to tell me to remove
my shoes and socks. Sure enough, even though I didn't know about it as it isn't painful.

Neither are my hands painful. The protractor shows I can open my LH ring finger 65º from 90. Or it you look at it the other way, if I try to lay my hand flat on a table, the finger is all done at 125º from 180. The middle finger is better by half. RH is only about 170 off the table. The doc said I'd be back when I couldn't get my hand in my pockets anymore. That was 10 years ago. Xiaflex was new to the game then. They did a lot of open hand surgery then and that's a messy deal. Long healing process and painful.

That doc retired 2 years ago.

So, I did go to see a new doc recently that does the Xiaflex injections. He said no problem with my severity but I'd have to wear a brace most of the time for a month. 6 months while sleeping as DC has a tendency to return.

He wouldn't do it though until I resolve my shoulder issues. I need a 2nd replacement for the one that failed due to infection after 2 years. This is because when they do the straightening, some tissues and even skin can tear. It's a violent procedure like slamming a huge book on your hand to break the plaque. Infection can be a problem in rare cases. They numb you up before doing the instant straightening, at least that's what another patient told me.

The is an intermediate surgery that Noah can expand on. They make a slit and do a bunch of criss-cross incisions to weaken the plague and then put you in a brace.

You're dealing with a tendon here so it can't be just removed. The old fashioned method is to open the hand on the palm side from just up the fingers and towards the wrist 2 to 3" to scrape the plaque off the tendon.

BTW, and I don't mean to gross anyone out, but Peyronie's disease is much the same. I had a bout with that 25 years ago and it was treated with an oral medicine that restored to normal any difficulties. I've been fine since.

And finally, it is hereditary and affects certain northern European Caucasians more than Asians or Blacks. That would be my ancestry for sure. My aunt had Dupuytren's just as bad in her hands as I do. Se had a lot of foot problems as well. Thankfully, I've avoided that (with the exception of bad shoes — see my thread).

Some natural remedies can help along with abstinence of alcohol. Alcohol just exacerbates the problem.

Both of the above pictures look like Dupuytren's disease. Often starts in the your 40s or 50s. Maybe with firm nodules in the palm, by the palmar flexion crease. Then it may start forming firm subcutaneous cords that run into the fingers. Ring finger is the most common, followed by the small finger and sometimes the middle finger. Rarely the index or thumb.

Somehow the fascia (connective tissue) in the palm gets turned on. We're not sure exactly why. It's genetic, linked to northern european ancestry. Usually it's not painful. There's not much you can do about it. It wasn't because of anything you did. It's not linked to any other diseases or medications. There's no medicine or therapy or splinting you can do to make it go away.

Rarely is it painful.

Usually we leave it alone until it starts causing flexion contractures in the fingers. That's when those Dupuytren's cords start contracting/shortening to the point where you can't straighten your finger, even by putting your hand on a flat tabletop. That's when we intervene, because that's when the function of the hand gets impacted.

Your traditional choice of intervention was to cut it out. Partial palmar fasciectomy. Cut out all the cords and nodules, to allow the finger(s) to straighten once again. It's a surgery.

Another option is just to slit the contracting cords to straighten the finger. Instead of a full surgery, we just numb up the palm/finger(s) by some local injections. Then we take a hypodermic needle, and use the tip of it to cut the cords. The tip of a needle isn't perfectly round, like the end of a cylinder. Rather, the tip of a hypodermic needle is a little beveled, like a knife tip. Imagine a cone with its tip lopped off on a diagonal cut. So we use that beveled tip to our advantage. We insert the tip of the needle through the skin (which has been anesthetized), and then swish it back and forth to use the tip to cut through the constricting cord. Do that at a few levels, and then that should allow the finger to extend/straighten back out. The "stuff" of the Dupuytren's is still there in the hand, but the finger can now straighten out.

The benefits of a needle aponeurotomy: It's not a surgery, so less recovery, cheaper. Can be done in an office, instead of an OR. No real post-op wound.

The negatives of a needle aponeurotomy: It leaves the Dupuytren's disease behind in your hand, so recurrence rate is greater. There are some situations in which you can't do it, such as if the Dupuytren's cords spiral around digital nerves and arteries. Most docs aren't willing to do it if you've had previous Dupuytren's surgeries on the fingers/hand, as the anatomy (and location of those nerves and arteries) may no longer be in expected locations. Possibility of nerve damage (because this is a bit of a blind procedure), which is usually permanent if you get it.

The 3rd option is a collagenase injection. Maybe around for the past 15 years or so. Better living through science, right? Inject an enzyme to dissolve the collagen cord. Similar concept to the needle aponeurotomy. Use a collagenase to dissolve a section of the cord, to allow the finger to straighten. The benefits: Just one injection (actually 3 per the technique, but they're given at the same site at the same time). Then you come back to the office in 2 or 3 days, and the doc stretches out the finger to pop the weakened Dupuytren's cord. The negatives: Cost. The company that manufactures the medicine charges about $2500 per shot. Your insurance may or may not cover that cost. The average patient requires 1.4 injections, per the literature. Meaning, some need one shot, some people need two shots. Factor that into the cost calculations. The collagenase doesn't attack just the Dupuytren's cords, but all connective tissue in the area. So it's normal to get localized or palmar bruising and swelling. There is theoretic risk of dissolving the underlying flexor tendons (that's a disaster if it happens), but fortunately it's pretty rare.

Maybe one of these for sleeping. Keeps the fingers from clenching.

https://www.amazon.com/ACE-Americas-Supports-Satisfaction-Guarantee/dp/B005YU8TMC/ref=sr_1_11?dchild=1&keywords=carpal+tunnel+sleepi ng+brace+for+right+hand&qid=1616190613&sr=8-11

Couple other thoughts:

Usually we only recommend intervention once you've got some finger contracture. But if the Dupuytren's disease is painful, that can warrant surgery even without finger contracture, because that's affecting function of the hand.

In the collagenase injection, because we're still leaving behind the majority of the Dupuytren's disease, recurrence can be an issue, as it is with needle aponeurotomy.

You wonder why we don't just cut the stuff out before it starts causing problems of contracture. The literature says that if you one day need a repeat procedure--a revision, because of recurrence of Dupuytren's, then repeat surgery averages a 50% nerve injury rate. That's permanent numbness, effectively, to half of a finger (or two halves of two fingers, depending on which part of the nerve gets accidentally cut). Once surgery gets done and scarring takes place, the locations of the digital nerves may not be where they normally should be. Scar tissue can wrap around the nerves. So repeat surgery is a bit of a minefield, with regards to potential for nerve damage (accidentally cutting a nerve). Why put yourself at higher risk for future nerve damage potential by doing a Dupuytren's surgery if there is no finger contracture yet? So we usually don't cut it out unless there's a contracture necessitating it.

Thanks for the explanation Noah.

Can I still find and pick up a 10mm socket?

When I started to get the chords and a few nodules, I ran into a holistic dr in the UK, very common there as you state above, it is a Northern European disease predominantly; known also as the Vikings Disease.
I mix a small bowl of boron powder with DMSO cream and magnesium oil. Create a slurry and rub it on your hands or better yet, slather it on and wear surgical gloves for an hour or so.
The boron seems to have a beneficial effect, the magnesium oil is good for the pain and the DMSO cream aids in penetration to the internal areas affected.
Only 3 out of 10 will develop to the point of hand closure but you won't know if you are one until the contractures begin, by which time it is often too late. As Noah states, it is rare for DC to be painful but I have heard of quite a few cases where there is significant pain, I know mine twitch from time to time and it isn't pleasant.
I have no real evidence that my concoction is the reason things have not developed but they haven't in 6 years gotten any worse, other than I now have the Ledderhose which is DC for the feet. So I have an old pair of sneakers I use to wear when I apply the slurry to my feet.
Massage of the hand is thought to speed up DC but massage of the foot is held to slow Ledderhose, go figure. There is a Facebook DC group, mainly Euros but up on all the latest techniques. Funny how many people have this, I can always spot them, the actor Bill Nighy tries to hide it but you can see it from certain angles. And of course Ronald Reagan had surgery for it during his term of office.

My neighbor a couple doors down says that her husband (he's British, probably around 60) switched to a vegan diet, and that cured it for him. There's no published science behind that, but if it worked for him then it worked for him.

My middle finger on my right hand contracts when I sleep....wakes me up from the pain. When I go to manually extend it, it's super painful. I've been wrapping my finger in tape before I go to bed in order to keep it from contracting in my sleep. Seems to work. I'd say it's a side-effect of having carpal tunnel surgery 2 years ago in that hand.

That sounds like trigger finger. Swelling of the flexor tendons in the fingers. It's indirectly related to carpal tunnel; both conditions arise from swelling from the flexor tendons. In the wrist, when the tendons swell, that compresses the median nerve, and you wind up with carpal tunnel syndrome. When those same tendons swell in the fingers, they get trapped and start triggering. So one doesn't cause the other, but both can share a common etiology in tendon swelling. The exact underpinnings are little more complicated, but that's kind of a simple explanation for the conditions.

If your triggering persists, then consider a cortisone injection. Hurts like heck for about 5-10 seconds, but then about 70% effective in curing the triggering. If injections don't work, there's a simple surgery (release part of the constricting sheath around the tendon) that will fix the problem with about 98% effectiveness.