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Average age for surgery
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01/03/22 01:20
LouiseLouise 
01/03/22 01:20
LouiseLouise 
Average age for surgery

Hi all,
I am new to this forum but I guess like most of you I have Dupuytren's.
I had a bad hand injury last April with displaced little finger break and in June the first three nodules appeared. I am 47 year old, no family history, not diabetic, no liver issues etc - so as far as I can see just the hand injury 8 months ago.
I have struggled since June with nodule pain and over the last two months can see the divets in my right hand (right handed office worker).
I have seen two.consultants who diagnosed DD (1NHS and 1 private) the NHS consultant is willing to see me again in a few weeks (3 month recall) the private consultant who is also the top Dupuytren's doc at the NHS hospital told me to come back in several years when the DD was causing issues (I explained to private consultant in September due to pain I cannot hold a pen, PC mouse, kettle, saucepan, steering wheel etc)
Anyway I can see that over the last week or two the angle from knuckle has worsened (could not be on flat surface when I saw either consultant) and the pain more unbearable.
So what age do people have one of the surgical options - I am concerned that being under 50 that the surgical options may need doing again in future - I have done a lot of research but none of the research advise of age of patients.
If this is incoherent at any point please ask for explanation, I am scared of what is happening to my hand and that it's useless and really painful and being told come back in several years when It gets worse :-(

01/03/22 03:17
newman 
01/03/22 03:17
newman 

Re: Average age for surgery

Hi sounds like the injury has triggered Dupuytrens. It is not clear is the Dupuytrens in the same little finger?
Like any disease the younger you get it can be a negative . It is common for men in their 50s with women 10 yrs later to show signs of the disease. Generally the pain which you describe is not common with DC. Is the contraction occurring in the pip (middle) joint . Any lumps within the hand are referred to as cords or nodules the latter being the first to form .The stronger Voltaren 23% is a good start to relief pain . I started to show signs at 35 yr after a motor cycle accident . Check family members for the link Finally wait and see and always seek out a Hand or upper limb Surgeon if and when the time comes. Regards.

Edited 01/03/22 04:42

01/03/22 09:47
spanishbuddha 

Administrator

01/03/22 09:47
spanishbuddha 

Administrator

Re: Average age for surgery

Hi Louise.

Welcome to the club. There is alas no cure for DD, but there are several treatments applicable at different stages that for most people is enough to maintain functional use of the hands. Surgery is used to straighten the hand by removing cords and diseased tissue. It is not usually done to remove just nodules in early stages. DD can always recur although there are forms of more advanced surgery that may help prevent this from happening. Any trauma can instigate new instances of DD and this includes the surgery itself. As a generality surgery is probably best left for severe or difficult cases of contracture.

The info you need is on our website and the forum. As a summary the stages are typically: wait and see - because the majority do not get contracture and ii can go through dormant and active phases; steroid injections for sore inflamed nodules; RT for symptomatic early stages with nodules, cords but no contracture; NA and in the US Xiaflex for moderate contracture; and thereafter for more severe cases various forms of surgery. Alas it can always come back but most people successfully either enter a holding pattern or manage to keep good use of the hands by applying these treatments at the various phases.

RT in the UK on the NHS is possible but you need to get past the referral stage and find a clinic or hospital that will perform it. There are at least two private clinics offering RT and a free initial consultation. More from the BDS https://dupuytrens-society.org.uk/. For symptomatic relief from pain as newman says try topical voltarol, ice or heat, a steroid injection, compression gloves, gentle massage.

Edit to add, the age for surgery is not really a factor. Age is more of a factor for consideration of RT. The factor for surgery is the clinical indication, but there are as stated above non-surgical treatments that are more appropriate, useful and less traumatic for the earlier stages no contracture, pre-contracture and moderate contracture

Best wishes SB

Edited 01/03/22 10:57

01/09/22 01:12
LouiseLouise 
01/09/22 01:12
LouiseLouise 
Re: Average age for surgery

Thanks for the answers. It's three fingers affected middle finger to little finger - in the last couple of weeks the three fingers are at a 10-15° angle though difficult to tell with the little finger as the displaced fracture did not heal well and is an odd shape these days.
The pain from the hand is bad, I am using the high strength voltarol and 90mg duloxatine for nerve pain but still unable to use my hand for anything like holding.. The pain has been intense from about June last year and I am so fed up now with being told it's just a phase that will ease, In 8 1/2 months I've gone from nothing to painful nodules, divetrs in my hand and three fingers that fail the desk hand laying flat test . (And knuckle pads on a couple of finger's) I am so frightened it's moving this quickly.
I should have a check up next month (UK NHS) I will keep you all informed.

01/09/22 10:01
spanishbuddha 

Administrator

01/09/22 10:01
spanishbuddha 

Administrator

Re: Average age for surgery

Sorry to hear of your ongoing problems. Would you say the pain is coming from the nodules, cords, or related to the prior injury which it seems was not set properly for healing? Can you post a photo of the fingers and palm. If the 3 finger contracture is caused by cords on the palm you could have them corrected via NA on the NHS, but like so many others you'd have to join the queue backlog, and this might not help with the pain. It sounds like CRPS and not typical DD symptoms of tenderness, soreness, cramps, pulling, pins and needles, aches. At your next appointment discuss possible sources of the pain, the original injury, ongoing little finger/joint displacement, or the growth and contracture of cords associated with DD. Also ask about NA if the cords in the palm are quite visible or palpable. Best wishes.

01/11/22 12:13
newman 
01/11/22 12:13
newman 

Re: Average age for surgery

Hi I wouldn’t stress over knuckle pads if on mcp joints . I would certainly being seeking an X ray or CT scan and ultrasound sound on the injury . Hopefully no nerve damage , May be worth having a nerve conductive test as well .

Edited 01/11/22 23:52

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