I had a 90 degree contracture of my little finger. I had surgery 12 years ago and the finger is still perfect. I do remember my surgeon saying that if I waited much longer the procedure would have to be done in two separate surgeries.

If left alone, your finger could continue contracting into your palm. Then amputation enters the picture. Or, your finger could stay in its present condition. Everyone is different and the disease is unpredictable. If it were me, I would have surgery at your stage, but just as the disease is different for people, there are different ideas on what should be done.

Why does amputation enter the picture? I mean, wouldn't it be possible to just cut the tendon or something like that if you're going to that extreme?

spanishbuddha:

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GeneralTHC:

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Why does amputation enter the picture? I mean, wouldn't it be possible to just cut the tendon or something like that if you're going to that extreme?

A cord is not the tendon but a build up of collagen. The difficulty that can arise is the cord gets entangled with nerves and blood vessels so that removal or severing becomes a problem, and whatever happens is a useless finger because of other tendon or joint changes. If left in a tight contracture there can be fungal skin infection and so for some the finger may be best removed.

If you read this site you will see that NA, when the cord is indeed severed, is a viable treatment if the contracture is not too advanced or been left too long.

No, cords are not related in any way to tendons or tendon sheaths. There are other structures in the hand that it seems to be more associated with DD. It's a false appearance that cords follows lines of tendons, and in fact there is a theory about the direction of tension as to why cords develop this way. As callie says tendons suffer as a side effect due to lack of use.

In the UK the gold standard for treatment has been surgery for many years. Leave it alone until there is a contracture and then cut it out. For many this is successful. But there are risks and problems. A surgeon may not be able to identify all of the DD cells. The act of healing may promote new DD growth. The physio for recovery can be long. Other risks from surgery including infection, pain, nerve or other damage. The skill and experience of the surgeon seems to make all the difference. So, treatments that are less risky have been developed, including NA and now the use of the collagenase enzyme Xiaflex. But none of these treatments tackle the source of the problem, the unwanted creation of collagen, and so the nodules and cords may recur after treatment. In fact there are many sad user experiences on here of people who are convinced that these interventional treatments have caused their DD to flare up and become more active.

For early stages of growth whilst still active, there is the option of using RT to slow down or halt progression. Even this does not work for everyone and of course has its own risks.

There are studies of using splints, at night, to keep the hand and fingers straight, after surgery, NA or Xiaflex. I don't have the latest data, but what I recall is that the evidence speaks to whatever conclusion you desire. This may be wrong. I myself started using a night splint (after RT) but now don't bother.

Edited 01/21/14 10:17

Can you take your other hand and straighten the finger? If Dupuytren's you wouldn't be able to do that without major pain.