Another hand thread

[Zeke]

Who here has had Dupuytren's disease? I've had the lumps for 10 years but now I'm starting to get where I can't straighten my ring finger. Or at least bend it back.

I read that some kind of injections might work for now.

[Tobra]

You can get those knots on the bottom of your feet or even on your penis too. Maybe steroid injection, but you very well may end up getting surgery.

[Zeke]

I think you scared everyone away with talk about an penis. Yes, I've read about the correlation between Peyronnies disease and the lumps in the hands and on the plantar fascia.
I have no other problems and am wanting to know about injections to the tissue.

I see the gen physician in a week and he will give me a referral to a hand guy. Looking to know in advance about options.

[Tobra]

It depends a lot on what exactly is going on.

It may be something going on with the tendon, what you describe sounds more like a trigger finger than palmar fibroma, but I am no hand guy. I am told that a steroid injection in the palm of your hand is more than somewhat uncomfortable.

For the stuff I deal with , you dissect out the affected area, or strip the entire fascia out. Risk of recurrence is fairly high at the edge of the area removed.

[Bill Douglas]

Was it George on Seinfeld who was discovered to have beautiful hands; and could be a very successful hand model. It was recommended he move to LA, where in the hand model industry, he would get more hand jobs.

[jyl]

Milt, see your PM

[sammyg2]

It fall off in two week anyway!

(Old joke but it cracked me up)

[Noah930]

You have 3 treatment options.

Traditionally Dupytren's has been treated with surgical exicision. The abnormal cord gets cut out. It's called a palmar fasciectomy. The bad part is that you've got a big wound (size of the cord) in your palm and finger(s). But surprisingly it heals well, though that may take a month or so.

More recently (last 5 years or so) people have been doing percutaneous needle aponeurotomies. Think of slicing a banana with a needle without peeling the banana. You insert a needle through the banana peel at varies levels, swish it back and forth to slice the banana, but never have to actually peel the banana. That's effectively what's done to the cord in your hand/finger. Local anesthetic is administered in the office/minor op room. Then a larger needle used to cut the cord at various levels. The good: quicker recovery, less cost. The bad: you don't actually remove the material, so recurrence can be an issue. (Even with formal surgery you can have recurrence, but at least you're removing diseased tissue in that situation.) The digital nerves are close by the Dupuytren's cord, so a potential complication is cutting the nerve, which leads to permanent numbness in half the finger. Still, needle aponeurotomy is a good way to go.

Last February (2010) a company finally released a collagenase called Xiaflex. It's an injection that dissolves the Dupuytren's cord. You get the injection one day (actually 3 quick injections right next to each other), and the next day return to the office to stretch out the finger and pop the weakened cord. Sounds great. But it can be expensive, as the medication is going for a couple grand. No insurance wants to cover it, though Medicare is. In clinical trials, each digit needs an average of 1.4 injections. So maybe it'll be fixed with one injection. Or maybe you'll need 2. That's a big deal if you're paying for the medication. There can also be some impressive bruising to the palm which looks horrible, but at least that's temporary. No data on recurrence rates, yet. But conceptually you're at least getting rid of some diseased tissue, unlike in needle aponeurotomy.