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03/09/2012 14:46
pia2some 
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03/09/2012 14:46
pia2some
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Questions
I'm just curious about something. When you talk about the degree of contracture, can that be measured in several places? Do they measure at the PIP and MCP joints? When I saw Dr. Costas he had me lay my hand on the table and then he measured the angle of the knuckles across the back of my hand, not on my fingers.
My pinky has the most visible cord. It runs from my palm into the MCP joint and there is a huge knot on the inside of my hand on the MCP. You can see that cord from a mile away, yet that finger isn't really contracted nor does it feel tight. The ring and middle finger don't seem to contract at the PIP or MCP joints. But each finger is being pulled down. It seems to pull more at the base of the finger where it's going into the palm. Those two fingers feel extremely tight and that tightens runs down into the palm. If that makes sense.
Anyway, just wondering where the different measurements occur.
~dawn
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03/09/2012 15:00
pia2some
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03/09/2012 15:00
pia2some
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Re: Questions
Oh wait!! I've got my anatomy confused. Looking at your fingers ... the first joint under the fingernail is the DIP. The next joint down is the PIP. Then the joint where the fingers and the palm come together is the MCP. Is that correct?
So when the doctor measured the bend of my knuckles as my hand was on the table, he was measuring the MCP contracture?
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03/09/2012 16:01
callie
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03/09/2012 16:01
callie
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Re: Questions
Best explanation on this website is under "Disease" (above) and then click on "Stages and therapies".
Are your other fingers being pulled down by the contracture in little finger, or are they also involved with Dupuytren's?
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03/09/2012 17:24
spanishbuddha  Administrator
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03/09/2012 17:24
spanishbuddha Administrator
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Re: Questions
pia2some:
Oh wait!! I've got my anatomy confused. Looking at your fingers ... the first joint under the fingernail is the DIP. The next joint down is the PIP. Then the joint where the fingers and the palm come together is the MCP. Is that correct?
So when the doctor measured the bend of my knuckles as my hand was on the table, he was measuring the MCP contracture?
Yes and Yes.
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03/09/2012 17:32
pia2some
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03/09/2012 17:32
pia2some
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Re: Questions
callie:
Best explanation on this website is under "Disease" (above) and then click on "Stages and therapies".
Are your other fingers being pulled down by the contracture in little finger, or are they also involved with Dupuytren's?
Okay, so I can have contractures and still have fingers that remain straight. I think that was what was confusing me. So often I think of Dupuytrens as the fingers curling/bending in toward the palm. I don't think of having contractures in the MCP joint and fingers that are straight.
I have three cords. Pinky, ring and middle fingers. The pinky is the one where you see the cord that runs from my palm up to the PIP joint. It's very obvious. It's beginning to contract a bit at the PIP but not a lot. The middle and ring fingers are being pulled downward from the cords at the MCP joints. But the fingers themselves remain straight.
I'm now scheduled for Xiaflex injections on April 10. I'm not sure which fingers he is planning to treat first. When the office calls back in another week or so to go over insurance info I will ask more questions.
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03/09/2012 19:01
callie
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03/09/2012 19:01
callie
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Re: Questions
You can have cords/nodules that may, or may not, contract. Did you look at the "Stage 2" diagram in the above reference? It showed a straight finger contracting at the MCP joint. It is my understanding that contracture occurs when the joint angles are changed from the normal. The measure of contracture is the measure of change from normal.
"The slow, progressive and irreversible shortening of connective tissue is called contracture. This term must be distinguished from the term contraction, which is used to describe the rapid (and reversible) shortening of skeletal or smooth muscles. This distinction is important when one speaks of contracting myofibroblasts in the aponeurosis of Dupuytren's disease."(Moermans, 1997)
Edited 03/09/12 21:21
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03/09/2012 19:38
pia2some
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03/09/2012 19:38
pia2some
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Re: Questions
callie:
You can have cords/nodules that may, or may not, contract. Did you look at the "Stage 2" diagram in the above reference? It showed a straight finger contracting at the MCP joint. It is my understanding that contracture occurs when the joint angles are changed from the normal. The measure of contracture is the measure of change from normal.
"The slow, progressive and irreversible shortening of connective tissue is called contracture. This term must be distinguished from the term contraction, which is used to describe the rapid (and reversible) shortening of skeletal or smooth muscles. This distinction is important when one speaks of contracting myofibroblasts in the aponeurosis of Dupuytren's disease."(Moermans, 1997)
Yes, I did look at the pictures and diagrams. The degree of contracture in my right hand is 30 degrees for my ring and middle finger and 25 degrees for my pinky. So it's not as severe as the ones in the pictures. It has progressed a lot since I saw the doctor for the first time in January. At that time, my left hand was really okay except for a few nodules and we were just focusing on the right hand. Now on my left hand, the ring finger is pulling down and my whole hand is very tight.
I'm also having a lot of pain in the right hand. It just aches and throbs all the time. It's stiff and bent when I wake up and it does loosen up but takes a while.
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03/09/2012 20:36
callie
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03/09/2012 20:36
callie
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Re: Questions
Your progression is similar to the way mine rapidly progressed. I went from 0 degrees contracture to about 135 degrees (from looking at the pictures) in less than a year before I had surgery. I have read that the faster the contracture the less chance for recurrence. I don't know it that has been considered valid, but my finger is still at zero contracture following my surgery 10 years ago.
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03/09/2012 22:22
flojo
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03/09/2012 22:22
flojo
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Re: Questions
Pia,
My contracture sounds like you describe yours. Very first symptom was my thumb, then a cord across the palm to my little finger. Contracture in my fight has been in my palm and reaching up into the pinky and thumb originally. Now beginning to pull a little on my middle finger and a nodule on the finger side of the MCP.. Ring finger OK - so far.
Left hand - Dups is trying to get started in my left hand, but doesn't seem to be progressing as rapidly as it did in my right. Of course, this hand is different. It started first in my thumb but is connecting to the forefinger. Nodules are on both the palm side and finger side of my forefinger. Watching it all the time and have RT lined up if it get clearly active.
Just tooooo weird!
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