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Best options on PIP joints
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08/14/2013 03:32
pia2some 
08/14/2013 03:32
pia2some 
Best options on PIP joints

My pinky on my right hand is almost at a 45 degree bend at the PIP. There is a huge, huge nodule on the underside of the PIP joint. The cord runs from that PIP joint to about an inch from the end of my palm. The webbing between the index and thumb on that right hand has literally thickened overnight. I had several nodules there and now suddenly it is this very thick cord and is dimpled in along the top of that webbing. A cord has started in the webbing is running across my hand almost to where the cord coming down from my pinky is.

I had Xiaflex in the ring finger of that right hand so that finger is not as contracted but is beginning to contract again, just slightly.

So what have people found to be the best treatment option for that pinky PIP joint? I know it is a difficult one to treat. I'm waiting on approval to see a new hand doctor who is much closer to where I live. My funds are limited and I'd really like to go with the treatment that has the best chance of being successful. Just wondered what others here had done with that pinky PIP.

~ dawn

08/14/2013 06:36
wach 

Administrator

08/14/2013 06:36
wach 

Administrator

Re: Best options on PIP joints

My pinkie was pretty much the same: a huge nodule between PIP and MCP joint and a 45 contracture at the PIP. Cords were not prominent but buried deeper. I had Xiaflex injected 1.5 years ago. That relieved the contracture to about 25 degrees but did not fully correct it. The injection was not the optimal treatment because the cords were not prominent and difficult to inject into. I had Xiaflex nevertheless because I wanted to avoid surgery. I wore a night splint for 12 months and was able to avoid recurrence during this time. After I stopped wearing the splint the contracture came back to 45 degrees. So I am basically back where I started plus in the meantime a more visible cord into the palm.

Surgery might have yielded better results but the PIP of the pinkie is definitely the most difficult joint with frequent recurrence. I am still trying to avoid surgery as long as possible, specifically at the pinke. Maybe a PNF would have yielded better results http://www.youtube.com/watch?v=96_L9ZGt6x8 or a knife fasciotomy as Dupuytren himself had done. But it's a really difficult situation.

Wolfgang

08/14/2013 13:30
pia2some 
08/14/2013 13:30
pia2some 
Re: Best options on PIP joints

Thanks for sharing your experience, Wach. Yours sounds very similar to mine. While the ring finger isn't too bad since the Xiaflex, I did forget to mention the middle finger. It has a cord going from the palm up one side and this has now pulled the middle finger underneath the ring finger.

So there are 3 fingers majorly affected in that hand - the pinky, middle and thumb. All have cords that go to about the same point in my palm. I'm wondering if it's possible to work on all 3 of those in one procedure. The last time I saw the hand doctor was in April and this has all gotten much worse since then. Now I've found this doctor closer to where we live and I'm just waiting for an appointment with him. Hopefully it will be soon.

~ dawn

08/14/2013 14:00
callie 
08/14/2013 14:00
callie 
Re: Best options on PIP joints

As most are aware, my little finger was over 90 degrees contracted with the PIP very much involved. I had surgery over 11 1/2 years ago. The finger still is at 0 degrees contracture and you can't tell I ever had Dupuytren's. Naturally, everyone is different.

08/14/2013 14:06
pia2some 
08/14/2013 14:06
pia2some 
Re: Best options on PIP joints

callie:
As most are aware, my little finger was over 90 degrees contracted with the PIP very much involved. I had surgery over 11 1/2 years ago. The finger still is at 0 degrees contracture and you can't tell I ever had Dupuytren's. Naturally, everyone is different.

Yes, I remember your story and am encouraged by it. :) Were any other fingers affected at the time of your surgery? I'd just like to take care of all three at the same time, but maybe that's not possible.

~ dawn

08/14/2013 14:14
callie 
08/14/2013 14:14
callie 
Re: Best options on PIP joints

I had involvement (dermal pits) with the index finger at the time. The index finger has not changed during the last 12 years. It has been dormant at about 5 degrees contracture.

I would not know if your situation could be "fixed" in one procedure. I wouldn't be surprised if that answer might vary with responses from different surgeons.

08/14/2013 14:17
pia2some 
08/14/2013 14:17
pia2some 
Re: Best options on PIP joints

callie:
I had involvement (dermal pits) with the index finger at the time. The index finger has not changed during the last 12 years. It has been dormant at about 5 degrees contracture.

I would not know if your situation could be "fixed" in one procedure. I wouldn't be surprised if that answer might vary with responses from different surgeons.

That's why I'm anxious to see the new hand doctor. I'm stunned by how fast the changes in the right hand are occurring. My left hand is even worse, but since my right hand is the dominant hand, I'd like to work on it first.

~ dawn

08/14/2013 19:28
moondanc 
08/14/2013 19:28
moondanc 
Re: Best options on PIP joints

pia2some:

That's why I'm anxious to see the new hand doctor. I'm stunned by how fast the changes in the right hand are occurring. My left hand is even worse, but since my right hand is the dominant hand, I'd like to work on it first.

~ dawn

I'm going to have at least three digits done on both hands-- NA-- next month. I'll let you know how it turns out--I am having "twilight sleep" for the first time instead of a local. I think it depends on the surgeon and to me it's worth it to fly all the way across the country to get a top hand surgeon-- Dr. Pess.
With Dr. Eaton I had two fingers (all I needed at the time) each hand plus lots of palm work.

Diane

08/14/2013 19:45
moondanc 
08/14/2013 19:45
moondanc 
Re: Best options on PIP joints

wach:
My pinkie was pretty much the same: a huge nodule between PIP and MCP joint and a 45 contracture at the PIP. Cords were not prominent but buried deeper.

Wolfgang

I have this same situation - huge nodule between PIP and MCP-- and this is the first time I've had nodules in this place--in my pinkie and 45 degrees contracture. In my ring finger, the one injected w/Xiaflex but at that time only the MCP joint was affected--I have the same situation-- huge nodule between PIP and MCP but only 30 degrees. I also have a big nodule between MCP and PIP on index finger, cords but no contractures yet. (One of the things that makes me wonder what the real definition of "active" is whether RT could still help me. Do I need to wait for nodules between PIP and DIP? On Xiaflex injected finger I have cords up the sides!

In other hand, both index and middle fingers nodule between PIP and MCP--about 35-40 degrees.

I'm Diane, I'm gonna be your guinea pig--we shall see how this all turns out.

08/14/2013 20:00
pia2some 
08/14/2013 20:00
pia2some 
Re: Best options on PIP joints

moondanc:
wach:
My pinkie was pretty much the same: a huge nodule between PIP and MCP joint and a 45 contracture at the PIP. Cords were not prominent but buried deeper.

Wolfgang

I have this same situation - huge nodule between PIP and MCP-- and this is the first time I've had nodules in this place--in my pinkie and 45 degrees contracture. In my ring finger, the one injected w/Xiaflex but at that time only the MCP joint was affected--I have the same situation-- huge nodule between PIP and MCP but only 30 degrees. I also have a big nodule between MCP and PIP on index finger, cords but no contractures yet. (One of the things that makes me wonder what the real definition of "active" is whether RT could still help me. Do I need to wait for nodules between PIP and DIP? On Xiaflex injected finger I have cords up the sides!

In other hand, both index and middle fingers nodule between PIP and MCP--about 35-40 degrees.

I'm Diane, I'm gonna be your guinea pig--we shall see how this all turns out.

You sound like me! I have nodules on every PIP joint in my right hand. The pinky is the worst because it is huge and has the 45 degree contracture. Cords up the side of my middle finger. The webbing between thumb and index finger is thickening by the day with a cord. Nodules all throughout my palm and cords going down and across. I had Xiaflex on the ring finger and it's contracting again.

My left hand is a mess too. Nodules in the palm and on ring finger but none of the other fingers. My palm is so puckered that my whole hand looks deformed.

I'll be very interested to know how all of your NA work turns out. That is a lot at once. I wish you the best with it.

~ dawn

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