Hey all,

First, thank you all for your contributions to this site and these forums! I've already found so much useful information on here. It's really been a massive help. I apologize this will probably be a pretty long post, but I'm very anxious and would love to hear some advice.

A little about myself. I'm a white, 27 year old male of mixed European dissent (Irish, German, Czechoslovakian, and some unknown). I've been doing a lot of rock climbing and mountain biking over the past year. I recently developed a painful ~1cm nodule in my right palm between my middle and ring MIP joints. I can still fully extend both fingers, but not beyond flat like I could a few months ago. I can no longer do push ups with my palms flat and wrists at ~90deg. I do have a history of trauma to the hand including countless minor falls and two prior surgeries. One was a multiple fracture repair of metacarpals 2-4 back in 2008 or 2009ish, and the second was a vascular malformation excision in 2010ish. The latter was in the exact spot where the new nodule has now formed. My initial assumption was the vascular malformation is now recurring.

I met with a hand specialist about it on Monday and his initial diagnosis is Dupuytren's. I had an MRI done as well, but I'm still waiting on my follow up next week. I hadn't heard of the condition before this, but I'm inclined to believe him based on what I've been reading online. I suppose there's a chance it could be an unusual ganglion cyst or something, but the doc seemed pretty sure of himself and I do have most of the risk factors other than age and family history. To be honest, I'm feeling a pretty scared and anxious especially considering I'm only 27 and type for a living (software engineer).

While we're still not 100% sure it's Dups, I'm trying to be as proactive in fighting it as I can in case the doc is right. Just reading about the prognosis, I've already decided that it's time to grow up and start taking better care of my body. I plan to cut way back on rock climbing and mountain biking and focus more on generally safer exercises like weight lifting, swimming, and running.

The doctor told me he'll most likely want to do an open fasciectomy, but I'm feeling pretty hesitant considering I've already had two prior surgeries on the hand and one of them seems like it almost surely contributed to the early onset given the location of my nodule. I'm pretty sold on getting RT as soon as possible. My main worry with that is if RT isn't enough to reduce the pain, then I may want to get some form of surgery down the line. But would getting surgery after possibly trigger the disease again? Would I be better off getting the fasciectomy then RT shortly after to help prevent recurrence? That would probably give me full range of motion back, but would it reduce the effectiveness of the RT? Also, I feel like I'm very young to be getting my third surgery on that hand already!

Any advice or experience or studies regarding surgery before or after RT would be much appreciated. I think just having an attack plan and possibly getting the ball rolling for the RT will help me feel a little more at ease.

Edited 09/27/15 00:55

Thanks for the input!

I'm not sure why he wants to do an open fasciectomy already. I'm guessing it's because the nodule was very tender and causing me considerable pain when I saw him. When he mentioned Dupuytren's I didn't know anything about it, but I should be much better equipped to discuss my options with him at my follow up. Maybe he isn't the best doctor for me.

You're probably right about holding off. Just these past couple of days the pain seems to have reduced to a much more livable level. Even just the past day since my first post it seems to have gone down a bit. I guess the question then would be, do I get RT now, or wait for a bit and see if it's gone dormant already? It's possible that the flare up was caused by a recent blow to the hand, and if I just take it easy maybe I can put off treatment for a few years.

Or maybe it's not even Dups. I'm praying it's not, but like I said, I want to prepare for the worst.

I found a couple interesting reads regarding "non-Dupuytren's disease of the palmar fascia" and how it differs from actual Dupuytren's disease. I think this somewhat addresses the questions in my previous post in case any others are interested:

http://dupuytrens.org/DupPDFs/2005_Rayan_1482.pdf

http://www.ncbi.nlm.nih.gov/pubmed/16203068

I come from a pretty large family and as far as I know there is no history of Dupuytren's. Also, I only have the one nodule in a fairly atypical location on my palm. So it sounds like I may not actually have Dupuytren's disease but rather what these authors are calling "non-Dupuytren's palmar fascial disease". There's still a chance that I do have the Dupuytren's gene(s), but only time will tell.

That definitely eases my worries a little, but I also still don't know what's going to happen with this recurrent vascular malformation in my hand.

Edited 10/02/15 22:01

Hi there I would be more worried about Vascular Malformation than Dupuytrens. You say the surgeon "thinks" you have both . For me that is not good enough. You need to know either you have the disease or not. (Second Opinion needed) Google Thrombocythemia and Thrombocytosis which relates to Vascular Malformation in the hand.You might or not have the systems .It is suggested to have that blood tests and MRI scan. Blot Clots and Dupuytrens do not go together. Seek another opinion in a larger institution ,which has experience in Vascular Malformation first. Keep us posted.

Edited 10/02/15 18:11

Hi I am in Germany at the moment and know a couple of people that went into the emergency here with pain in the leg suspecting possible thrombosis. They immediately took blood to identify any high markers in the blood. Once identified one stayed in overnight for further blood test then ultra sound the next day. They were prescribed special blood thinners to be taken for 3 months plus a stocking . If it was me I would not be waiting months . If blood clots move they can finish up any where in the body. They can be life threatening
Get a second opinion. Regards