Can anyone post the scoring system that Prof. Seegenschmiedt uses to determine if RT is an appropriate treatment for an individual's Dupuytren's case? I've seen references to it in this forum - indicating that it's based on six questions, but I can't find what those six questions are or what the scoring system is. I also would like to know if there's a method for determining if your DD is in the active state. I was recently diagnosed with DD and have several (3-4) nodules in the middle of my palm. They are a bit tender, but I don't have any obvious cords and no contracture. I think I first noticed the nodules about 6 months ago, and I can't really tell if they've changed any. They feel pretty hard to the touch. I'm considering RT, but would like to know about more about the active symptoms and Prof. S's scoring system.
You should keep a record, weekly or monthly, with photos and possibly measurements of your hands/feet. That way you will know if there has been a (recent) change.
ProfS will perform an interview and an examination.
The interview will ask about: Trauma, Daily activity and Profession, Peyronie, Ledderhose, Diabetes, Smoking, Glucosamine, Other familiy members, Liver, Perfusion, Keloids, Frozen shoulder.
Also since activity is important, the onset and timing of: Itching/burning, Palm skin tension changes, Grip pressure, Pain at rest and with strain, Skin changes, Nodules, Cords, Flexion deformity. Changes and activity in the last 4 weeks, 3 months, and 1 year are of most interest.
The examination includes palpation of nodules, cords, Garrod's Pads, skin blanching, extension, joints, fine and coarse motor activity.
mvmarin:Can anyone post the scoring system that Prof. Seegenschmiedt uses to determine if RT is an appropriate treatment for an individual's Dupuytren's case? .........
Mvmarin, I don't know Prof. Seegenschmiedt's scoring scheme but it seems clear that right now your DD is very active as evidenced by the 3 or 4 nodules that have developed over the past six months. In the 2010 paper by Betz et al. "Radiotherapy in Early-stage Dupentren's Contracture", they show that RT treatment within 12 months of first diagnosis is the most effective. The figure below is from that paper and it shows that after a 13 year follow-up the results for the early stage RT treatment is the best. The blue bars show that only 2% of hands treated within the first 12 months of diagnosis progresed and 24% actually regressed. There were 115 hands in the < 12 month category. So, it seems that early treatment is best. However, Betz does recommend that the pogression is confirmed by the RT therapist over a 6 month period before the actual RT treatment is applied.
After seeing two experienced hand surgeon and one having performed hundreds of NA procedures I went to receive XRT in Essen from Prof. Seegenschmiedt. After he palpating my hands he stated that it was of course in my dominant hand where the NA has been performed, but he also noted that it was rapidly progressing in my other hand as well. This was missed by the other two hand surgeons and resulted in my having both hands treated.
The average doctor without hands on experience could easily miss the degree to which the disease has progressed under the skin. Nodules and a PIP contracture are easy to spot and dianose but other areas are more difficult for a doctor to detect.
According to the professor based on decades of treatment and research the earlier the diseased areas are treated the more effective the treatment will be in slowing the progression of the disease. I would not wait to get XRT as in two years time it may not be effective at all with the disease at a later stage. In this respect it is like cancer where early treatment greatly impacts the probaly outcome.
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