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Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)
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11/18/2017 08:59
alessandro.s 
11/18/2017 08:59
alessandro.s 
Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

Very short for now... about to turn 49, male, from Italy, no previous known occurrence in family, no diabetes, non-smoker, alcohol in limited amounts (like beer or wine twice a week at dinner).

Timeline is:

6/2017 - developed De Quervain in right wrist because of constant play with my young kids, two boys about to turn 4 and 2, really active lads. Had to wear extensively (even at night) a hand tutor to deal with wrist pain.

9/2017 - after 3 months of tutor usage (even at night) and more careful wrist usage, De Quervain subsides - but two lumps pop up apparently ovenight in palm, under middle and ring fingers, with middle one more pronounced, pea-sized. Sometimes mild pain, especially while screwing milk bottle top, hand gets a little stiff. General practitioning doctor suggests I visit a hand surgeon specialist.

10/2017 - visit to hand surgeon gets me a diagnosis of Dupuytren, with palm test on flat surface. I start reading about Dupuytren.

Today is my third day of self-exercises in un-stiffening the hand - which I probably am at an advantage with, considering I have hypermobility likely because of (undiagnosed) Ehlers-Danlos:

- can still bend several fingers on the left hand and index of the right hand to touch the back of the hand
- have double-jointed left thumb
- can independently bend DIPs on index, middle, ring fingers on both hands (4 of 6 fingers still at 90 degrees)
- can touch tip of the nose with my tongue, very easilly
- have hyperelastic skin on neck and back of hands (can stretch it painlessly for a full 2.5cm / 1in)
- have mild mitral valve prolapse
- learnt to walk "differently" after being suggested tendon shortening surgery at ankle levels for both ankles at age 19, currently can bend ankles at 110 degrees on the outside
- tore both ACLs in knees, one at 21 and the other at 41

Surgeon said prolonged usage of tutor has nothing to do with Dupuytren, but it strikes me as a collagene-poor individual that I get an excesse-collagene disease out of the blue... so, in just 72 hours of occasional stretching (like, 30-60 seconds every 15 minutes) I have both nodules flattened and regressed by an estimated 30% and a definite return of mobility to the hand. Too bad I hadn't taken pictures of the nodules before, as I realize such an improvement sounds very strange; and I didn't think of doing that up front as I clearly didn't expect these exceedingly positive results.

Note that my concept of "stiff" finger for the affected ring and middle is - from flat palm with 0-angle straight fingers, I can "only" bend them backwards 90 degrees (it was 120 for the ring and full 180 for the middle just a few months ago).

So, it SEEMS to me that there might be a correlation between the three months of De Quervain pain with really limited movement of my right hand (and definitely no stretching) and the insurgence of Dupuytren - with at least some initial benefit in actually moving the hand.

Since I insisted (before reading the whole lot) with my surgeon that I wanted the nodules removed, he told me to undergo an ultrasound scan and "then we will see".

Of course after reading about surgery implications I am (heh) less adamant about that, and plan to keep going with stretching for a few weeks and see how things go...

11/18/2017 11:13
spanishbuddha 

Administrator

11/18/2017 11:13
spanishbuddha 

Administrator

Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

Thanks for sharing. Interesting to read your explanation of the links between your injury and the nodules. There could be other explanations, for example inflammation and healing. Also interesting to read the nodules are reducing as you stretch, so my own guess is they are not DD nodules but some other soft tissue swelling that is declining as you continue to recover, or collagen type 1 being reabsorbed, or joint ganglions going down. But who am I to argue with your Dr.!?

On some Facebook forums for DD and also Ehlers-Danlos, people report they have both conditions. Whether there is a link is hard to say, but as you say it all adds the mix.

11/18/2017 13:12
alessandro.s 
11/18/2017 13:12
alessandro.s 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

Indeed my hope is that the initial diagnosis of Dupuytren could have been wrong (though nodules did in fact have all distinct signs in shape, position, consistency causing reduced mobility and relatively mild pain - and of course still do, to a lesser extent).

That is why I still plan on getting the ultrasound scan and go back sometime in December to the surgeon (who is in fact a hand surgery specialist and does Clostridium histolyticum injections routinely) to get a second look to my hand. I will post back in some time.

11/21/2017 20:51
Curt 
11/21/2017 20:51
Curt 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

I was diagnosed back in the 80’s after I got my hand caught in a printing press. I used my hands a lot. Loading paper in presses is actually not that hand friendly.

Just thinking of what your saying here. After I took a managerial job it seemed to worsen.

I read .... read and read everything on Dupuytren’s. The under use thing strikes my interest. However in the last 3 yrs I’ve been installing floors and Kitchen cabinets. I went from 20 to 30% bend to past 90%.

Just had Xiaflex injection on my left hand and NA on my thumb. Wow to use my left hand again is spectacular.

Get a second and third opinion if you can.

Best

Curt

11/21/2017 23:32
alessandro.s 
11/21/2017 23:32
alessandro.s 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

A few days later, my nodule under the middle finger is regressed to probably 1/3 the size of what it was last month, while the one under the ring finger regresses slower, and I'd say it shifted slightly towards the finger itself.

Given how the feeling of something extraneous in the palm is now little more than a mild nuisance (compared with having a couple bolts under the skin and the medium pain in screwing on or off the baby bottle top), I might revisit the idea of "the nodules popped up overnight" - they probably went unnoticed while I was barely opening and closing my hand due to protecting from the wrist pain via the tutor, until I actually got back to using the hand.

Still plan to get an ultrasound scan in December and a subsequent visit to the hand surgeon - don't want to get too hopeful after everything I read and the images I've seen about this disease.

11/22/2017 03:44
Curt 
11/22/2017 03:44
Curt 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

Alessandro

I wound up not being able to pick up a glass of water with my left hand. My right hand is getting just as bad. However, I never had any pain associated with either of them. Unless I get my hand hooked on a door handle or similar...that hurts.

Don’t give up and my very best to your solution and recovery.

I look at it this way. There are good car machanics and bad ones. Find the best hand surgeon you can.

Keep us posted.

Thanks

Curt

11/28/2017 08:43
alessandro.s 
11/28/2017 08:43
alessandro.s 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

Back from the ultrasound scan, the two 17mm nodules have been observed and diagnosed as compatible with Dupuytren.

All fingers still move ok, there hasn't been any further improvement (nor worsening) since the un-stiffening of the first days.

Next up, book next visit with the hand surgeon.

12/04/2017 16:16
Opeashom 
12/04/2017 16:16
Opeashom 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

thank you guys for all the tips and information i found here. it is extremely useful for me as a newbie who needs answers.
also wanted to say, alessandro.s, please come back with updates, i'm really interested. may i ask here questions in case i would have some for you? thanks!

12/05/2017 13:32
alessandro.s 
12/05/2017 13:32
alessandro.s 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

Well I am a newbie too so don't expect anything too useful from me - just trying to contribute with my own experience to the much deeper knowledge of this community... feel free to ask about my case and I'll reply.

I haven't yet booked my hand surgeon control visit... but I'm going to.

It seems to me that palm nodules have stabilized, though some days they seem a bit harder and some a bit softer...

Can now bend ring finger backwards 110 degrees and middle 135 degrees (approx), which is almost as good as it gets from my hypermobile point of view

03/06/2018 14:32
alessandro.s 
03/06/2018 14:32
alessandro.s 
Re: Add another to the mix - Dupuytren maybe caused by lack of use of the hand (because of De Quervain)

Updating after a while...

I haven't been to the surgeon ever again and I'm a bit dubious about shelling out another 100EUR or so to see a puzzled face and a likely retraction of the initial diagnosis.

Yes, my un-stiffening exercises have restored full mobility to my hand and it's a couple months since I was first able to make joints pop again while bending middle and ring finger backwards.

Middle can do full 180 degrees backwards touching back of hand and ring is at about 150 degrees backwards - it won't get further as it's always been the "most stiff" of my fingers.

The nodules are still recognizable, mostly the ring one, but have further regressed - the middle one is almost entirely flattened. Puckering effect on the hand is likely distinguishable only by expert eyes.

I still have a MRI scan booked for July, but at this point I'm not sure it makes sense to want to know more.

What would you do in my shoes?

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fingers   Quervain   degrees   surgeon   diagnosis   contracture   dupuytren-online   backwards   another   understanding   because   un-stiffening   Dupuytren   characteristics   distinguishable   nodules   excesse-collagene   hypermobility   ultrasound   radiotherapy