Nodules, tightness and early contracture but no cords?
I had carpal tunnel surgery in August 2012. It was a success, but I developed nodules in that hand by December. I have five currently and think I may feel a sixth forming. I saw my hand surgeon in January. He thought the nodules might go away on their own, but that seems unlikely. He told me to return if I noticed cords. I do not see or feel cords, however, flexing my fingers back is difficult, my range of motion is limited by a general tightness and I can't straighten my index or pinkie fingers on the affected hand without using the other hand or a stationary surface for resistance. These two fingers are starting to curve toward the palm at the PIP joints. I think this is the start of contracture, but everything I see indicates that cords precede contractures. I do not have any palpable cords so I am confused.
Does this still sound like Dupuytren's? My surgeon was somewhat dismissive in January so I am not wild to go back. Is it possible to have contracture without cording?
I am linking a picture taken in January. I think you can see three nodules here. Two more are now visible. Do these look like Dupuytren's?
Re: Nodules, tightness and early contracture but no cords?
Yes, contractures can begin without discernable cords. Such was the case when I had contracture of the ring finger on my left hand. In fact, because I was in so much pain from the combined Dupuytrens and tenosynovitis, the surgeon operated on my hand before any cords were seen, when my finger was about 20% contracted. He did a palmar fasciectomy and a tendon release of my ring and middle fingers at the same time. That is really early to undertake a surgery for Dupuytrens, but my rheumatologist talked the hand surgeon to proceed, and the surgeon wasn't even sure it would resolve my pain. It did. It took time to recover from the surgery, but my hand is excellent now, after 14 years. I think the reason my hand has held up so well for so long may be because of the early intervention.
Such was not the case with my right hand. I did start contracting before discernable cords, but waited and waited, because I had no pain, and I just wasn't ready. I think the cords started to serious show themselves at about 10% contracture, but I'm not sure. However, by the time I had Xiaflex injections about 4 weeks ago, the cords were very pronounced and my ring finger was contracted to 35% MP joint and 30% on my PIP. My hand is excellent now, albeit still a bit bruised and mildly sore, but excellent. My MP is at 0% and my PIP is about 5%. Cords are still apparent, but Xiaflex will not remove them the way open surgery will. I sure hope this success lasts. Don't we all......
I think you're in a wait and see period, or some may suggest radiation therapy. I've never done that, so it's hard for me to recommend it.
Re: Nodules, tightness and early contracture but no cords?
Hi Diane. Your left hand sounds very similar to how DD started in my left hand but after NA, I now have a very discernible cord as well. I don't see how I can avoid surgery because I have so much pain and seem to have tendon issues as well. The finger is even more contracted now than it was 4 months ago before NA. I might try Xiaflex but don't see how it will fix the other problems (pain, cant bend it, large knuckle pad, large nodules). How long did it take you to recover from your surgery?
Re: Nodules, tightness and early contracture but no cords?
Angry looking nodules. Since December? So still quite early. It's difficult to say what happens next. Some continue quite fast and develop cords and further a contracture. Others settle down, go dormant. I have similar in one hand now since February. What to do is a good question. In my case I think they are stabilising, so I am keeping a close objective eye on it with photos, notes of symptoms,etc.
There's not much spare room in our hands, so swelling nodules, inflammation within swelling could cause stiffness, but not contracture. Try soaking your hands in very hot water, then gently palpate and stretch to see if you really have a binding that is causing a contracture. It is possible to have contracture without apparent cords, but I think the cords are really there in such cases, just deeper or to the side, and not so obvious until they harden.
Re: Nodules, tightness and early contracture but no cords?
They are angry looking; I like that description, and it seems fairly accurate. They do, in fact, hurt when pressure is applied so gripping the steering wheel, handle-bars, shopping cart, etc. is not much fun.
Thanks so much for the responses. I take heart knowing I am not the only one to have some contracture without obvious cords. I feel like the nodules have happened relatively quickly so I am not sure what to expect in terms of progression. I am going to see my rheumatologist tomorrow and will ask her opinion about whether I need to follow-up with the surgeon yet.
Re: Nodules, tightness and early contracture but no cords?
I just realized I sort of hijacked your thread. I'm so sorry.
The nodules on your hands look very similar to mine. I have had contractures of two PIP joints with no noticeable cords since last year. Initially my only symptoms were knuckle pads, then nodules on the palmar side of my fingers followed by contracture. Since the latest flare, I got nodules like yours and some of the cords can be felt and seen but they are still not typical. It's unfortunate that there's no way for you to know whether things will calm down on their own or progress. You may be at the right stage for RT, though.
Re: Nodules, tightness and early contracture but no cords?
This discussion is really helpful for me. I love seeing the pictures of hands that have been diagnosed with DD, as I know no one that has it. Here's a picture of my right hand today. The palm side shows the nodules. Also, my pinkie and ring finger will not push down when the palm is right-side up. I've attached a picture that shows how stiff they are. Is this typical of DD? Pat
Re: Nodules, tightness and early contracture but no cords?
PatJohnston6384:This discussion is really helpful for me. I love seeing the pictures of hands that have been diagnosed with DD, as I know no one that has it. Here's a picture of my right hand today. The palm side shows the nodules. Also, my pinkie and ring finger will not push down when the palm is right-side up. I've attached a picture that shows how stiff they are. Is this typical of DD? Pat
Pat, IANAD but it is hard for me to see anything wrong with your hand from the photo. No clear nodules or cords to my eye. Maybe some skin pitting in the palm, and nodules between the palm creases, maybe not? Perhaps the angle of lighting is wrong to show this clearly.
I can't push my pinkie and ring finger back far, but never could. On one of my hands that has a nodule below the PIP joint and in the palm, if I do push back, as you are in the photo, the skin blanches to white where the pressure from the nodules below displaces the blood. I don't see that in the photo. Have you had a confirmed diagnosis, with definition of stage, from your physician or hand doctor?
Re: Nodules, tightness and early contracture but no cords?
Pat; You hand doesn't look to bad to me. If you do have a confirmed DD diagnosis I would still suggest that you wait and watch rather than taking action that might stimulate the disease.
Attached are current photographs of my hands for comparison. I had NA on both hands December last year so this is a big improvement on where I was but the ring finger on my right hand is already starting to contract again.
Re: Nodules, tightness and early contracture but no cords?
cschieber:Hi Diane. Your left hand sounds very similar to how DD started in my left hand but after NA, I now have a very discernible cord as well. I don't see how I can avoid surgery because I have so much pain and seem to have tendon issues as well. The finger is even more contracted now than it was 4 months ago before NA. I might try Xiaflex but don't see how it will fix the other problems (pain, cant bend it, large knuckle pad, large nodules). How long did it take you to recover from your surgery?
I don't quite remember how long it took to recover from the surgery, to be honest. I was wearing a splint during the day for at least two weeks, but took it off from time to time to do my exercises and prevent my hand from becoming frozen in the straight position. Also, to prevent atrophy. I was in PT for so long before the surgery, and was getting absolutely nowhere. My hand was contracting, but I also had a tenosynovitis that prevented me from bending my fingers. The two diseases tugging against each other were just so painful. My rheumatologist talked the hand surgeon to proceed with the surgery, so off I went to the surgical center.
Once the surgery and post op pain began to resolve, about two weeks, I could finally begin to see some progress. I continued hand therapy 2-3 times per week for a few more months, maybe three months, then continued the exercises at home. I would say that all in all, it maybe took about 5-6 months from surgery to completely better. Today, fourteen years later, my hand is still perfectly straight, and even somewhat hypermobile. I've never had any issues with the cord that developed after the surgery at my thumb. It's just there, but I don't care. My hand is great.
I knew so little about how DC progresses when I had the surgery, but didn't have any reservations, other than just a typical fear of surgery in general, in undergoing the procedure. I had no idea that surgery could actually worsen the disease, so it wasn't even a consideration. Open surgery was my only option, and at that point, I was ready to try anything to resolve the tenosynovitis pain more than the relatively minor contracture at the time. Obviously, I have no regrets.
I'm 30 days post Xiaflex for my right hand and the results so far are remarkable. When I take my splint off in the morning, my hand is almost completely straight, even my PIP. I lose about 5 degrees within a few hours, but the doc said that's normal. I still have some minor pain in my palm and my PIP, but it's nothing but annoying in the bigger scheme of things. So far so good. As for you undertaking Xiaflex, I don't know how that would work. Have you discussed it with your hand doc yet? I did not have all these other issues when I did the Xiaflex. I'm also in the multi cord study, so if I did have those issues, I'm not sure they would have taken me into the study. Again, you need to see a doc who will weigh your options in the best light, and not try to force anything onto you. But that tendon release procedure that the doc did at the same time that he did the fasciectomy was a godsend. If I underwent the surgery for just that, I would have been thrilled. Maybe you should do two procedures.... first the tendon release, then the Xiaflex, or the other way around. I dunno. Just guessing, and maybe that is something to ask your doc.
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