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02/14/2012 22:33
callie 
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02/14/2012 22:33
callie
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Cord starts with nodule?
It seems like most people notice nodules first as their start of Dupuytren's? Is that a correct assumption? My first 20 years with Dupuytren's were without nodules (first one this recent nodule about four months ago). The first I noticed was the puckering of the skin which I thought was a callus for about five years. Then in one hand (little finger) the cord developed with 90 degrees contracture. The other hand just stayed with the "calluses" for 20 years without contraction.
Question, does RT work on the "puckering" or just on nodules? Is the "puckering, nodules and cord development independent of each other? The seem like three different aspects of Dupuytren's. Obviously from my experience cord development can occur without nodules. So another question is can a cord develop even though the nodules can be arrested?
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02/15/2012 06:51
wach  Administrator
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02/15/2012 06:51
wach Administrator
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Re: Cord starts with nodule?
Hi Callie,
one of classical papers on the development of Dupuytren's (pathogenesis) is by Vernon Luck http://www.dupuytren-online.de/downloads/luck.pdf. He describes the disease starting wih a nodule (the original tumor) and the cords developing from this nodule. Today most researchers would agree with that and consider the cord a reactive tissue. The cord is a reaction of the body to pulling forces on the original nodule and typically cords develop along those pulling forces (that's why they were first mistaken as thickended tendons). When there are no pulling forces, e.g. with nodules in the arch of the foot, then the nodules might keep growing and may eventually reach a considerable size. It is also observed that cords reduce or even disappear when the affected finger joint is stiffened by surgery.
Some patients, including you and me, report that they developed some cords without prior nodule. It's unlear whether this is a correct observation and what the reason and mechanism would be. It may well be that it started with a smaller nodule, buried a little deeper in the connective tissue and thus not noticed. Only when it converted into a cord, the cord was then detected.
Wolfgang
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02/15/2012 23:12
callie
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02/15/2012 23:12
callie
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Re: Cord starts with nodule?
Thank you for the link. It was interesting reading Luck's emphasis on the subcutaneous fasciotomy. I think you are right that the dermal pits are a variation of the nodules.
Edited 02/16/12 01:15
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