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In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel
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07/30/16 17:18
Angetori 
07/30/16 17:18
Angetori 
In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

Hi
I have had LD in both feet for the last two years. I had tried a steroid injection on my right foot (which made it worse) And have been wearing orthotics and that's helped a little bit. My feet are in constant pain not just the fibromas but the pain seems to have radiated out into other parts of my feet, which I have read on this forum is common. LD changed my life from being a very active person to someone who has to constantly rest because my feet hurt so bad
Recently in July I had both of my feet radiated by Dr. James Wong in Morristown , New Jersey. I am in between treatments and finish in September .
Right before my radiation treatments for my feet began I develop four nodules in my R hand very quickly and a cord starting to come through by my middle finger . This happened within a matter of three weeks.
I went to two separate hand surgeons who both never heard of radiation for DD ....one actually told me I had trigger finger . The other one told me to wait till I had a 10° bends in one finger and then he would give me a collagen injection. I wasn't happy with either . I was about to start my treatments with Dr. Wong for my feet , so
I decided through my research and speaking to Dr. Wong to go ahead and have my R hand radiated as it seemed to be fast spreading and aggressive. My dad had DD in his 80s that came on very quickly and pulled his hand into a fist so I was afraid the same thing would happen to me and I am only 50 years old.
I finished my first round on both feet and my right hand and I'm supposed to go back at the end of September to finish the second round .
Prior to my radiation I had a funny feeling in my thumb like a numbness . I told one of the hand surgeons about this and he told me I had arthritis in my thumb. I didn't give much thought to it and took his word for it that it was just arthritis.
So I completed my first round of radiation and the numbness in my thumb got worse. I went to another hand surgeon, a totally different one. He diagnosed me with Carple tunnel and again when I told him I had radiation on my hand he said he never heard of it for DD and actually got mad at me for having it done He told me that because of the first round of radiation that I had that there's really no way he can treat my carpal Tunnel. That splinting a carpal tunnel problem is only a temporary fix and in the long run surgery is the only way to correct the carpal tunnel before it does further damage to the nerve in my hand He told me my skin would not heal after the surgery because of my radiation and that there's really nothing he can do for me
When I try to explain to him that it was a low dose of radiation and only the first treatment he still didn't think that my skin could handle any kind of surgery and that the surgical site will not heal.
I am waiting for Dr. Wong my radiologist to come back from vacation so I can ask him but I was wondering if anybody had a similar experience as I am having .
I am so discouraged I thought I was doing the right thing by trying to stop these nodules growing on my hand only to develop another problem. Any advice or suggestions on this matter would be great and much appreciated

07/30/16 18:45
wach 

Administrator

07/30/16 18:45
wach 

Administrator

Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

To my knowledge, radiotherapy for Dupuytren does not or hardly affect healing. I had NA on a irradiated nodule and it healed within a day. I recall a medical publication where it was stated that even Dupuytren surgery after RT was no problem. I will dig out which paper it was.

In any case, usually Dupuytren disease and Carpal tunnel syndrom are usually in diffferent areas of the hand. Why should RT then cause a problem? Or was your wrist also irradiated?

Wolfgang

07/30/16 20:17
Angetori 
07/30/16 20:17
Angetori 
Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

Thank you so much Wolfgang your response is greatly appreciated and made me feel so much better about my situation
If you could dig up that paper that you mentioned that would be great.
Yes my radiation began right where my hand meets my wrist and extended out to all five fingers up to the second digit .
Thanks again for responding.

07/30/16 22:00
spanishbuddha 

Administrator

07/30/16 22:00
spanishbuddha 

Administrator

Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

Although IANAD, in a way similar to DD surgery is not the first choice for CT but (night) splinting of the hand wrist in a neutral position, and possibly anti-inflammatories. Given the DD activity in your hand I think I would certainly wait, if possible, before seeking surgery for CT but instead look for the conservative options. Maybe the two are linked in your case?

07/30/16 23:49
Angetori 
07/30/16 23:49
Angetori 
Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

Hi and thank you for your reply ... I agree that a conservative approach is the best . I have to go to for some nerve testing first to make sure that it is carpal tunnel and then have a night splint made and start there My understanding is the next step would be a steroid injection but I would rather start with the splinting first I too, am concerned about injuring my hand through surgery and possibly making my DD get worse or more nodules appearing.
I have search the Internet and there was some things written on this forum about the two maybe being connected I feel the carpal Tunnel coming into my left hand also now. On that hand I have Knuckle pads on most of my fingers but no nodules or cords.
It seems to me I'm in some sort of flareup I eat an anti-inflammatory diet and try to keep my inflammation down naturally without NSAIDS, but maybe I should take them every day until I feel this flareup is calmed down a bit
It's funny how the hand surgeon immediately suggested surgery without even suggesting splints or steroid injections or listening to anything that had to do with radiography He scared me by telling me that surgery was the only way to protect the nerve in my hand from nerve damage. After seeing that doctor I was feeling that I had done the wrong thing by choosing radiography for my DD.
My next steps are : Talk to my radiologist and also seek another hand doctor that is more up-to-date on DD and carpal tunnel.
I am also using the microphone on my iPad to type this ... No more fingers !

08/01/16 14:28
wach 

Administrator

08/01/16 14:28
wach 

Administrator

Surgery after radiotherapy

Here are a few papers adressing whether surgery is feasible after radiotherapy of Dupuytren's.

1. Boris Adamietz et al. "Radiotherapy in Early Stage Dupuytren's Contracture" Strahlenther Onkol 11 (2001) p 604 – 610
"Surgery is possible in case of progression, without an increased intra-/postoperative risk."

2. N. Betz et al. "Radiotherapy in Early Stage Dupuytren's Contracture - Long Term results after 13 Years" Strahlenther Onkol 186 (2010) p 82-90
... due to progression of the disease 42 cases experienced surgery after radiotherapy and "in 2 cases (5%) a delayed wound healing was observed."
To rate this result you need to compare it with the generally to be expected wound healing problems after Dupuytren's surgery. In a review of the literature on Dupyutren's surgery http://www.eplasty.com/index.php?option=...&Itemid=116 , Keith Denkler finds wound healing complications in 23% (!) of the reported cases.

Although it seems to be a common opinion of surgeons that surgery after RT is not feasible there seems to be no indication that this is actually the case. It seems to be simply a myth.

Where is this myth coming from? An example is the book by Peter Brenner and Ghazi Rayan "Dupuytren's Disease: A Concept of Surgical Treatment" (Springer 2003). They are showing in fig. 27a and 27b "Long-term damage after irradiation for digital-palmar flexion contracture: actinic ulcers of the first web-space and hollow of the palm". The pictures are drastic, looking like holes burned into the hand. The authors do not explain the medical history of those hands nor where those pictures are taken from but conclude "radiotherapy of the hand is now regarded obsolete" and "complications are usually seen by hand or plastic surgeons - who report them to warn others - and not by the radiologist who caused them", thus discrediting Statements from radiotherapists in general.

Wolfgang

"

Wolfgang

Angetori:
Thank you so much Wolfgang your response is greatly appreciated and made me feel so much better about my situation
If you could dig up that paper that you mentioned that would be great.
Yes my radiation began right where my hand meets my wrist and extended out to all five fingers up to the second digit .
Thanks again for responding.

08/01/16 17:21
spanishbuddha 

Administrator

08/01/16 17:21
spanishbuddha 

Administrator

Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

wach:

Although it seems to be a common opinion of surgeons that surgery after RT is not feasible there seems to be no indication that this is actually the case. It seems to be simply a myth.

Hi Wolfgang, just to be clear, I guess you mean 'surgery for Dupuytren's after RT for Dupuytren's', because afaik complications of wound healing and fibrosis are well established difficulties with patients who have had much higher doses of radiation for cancers.

The point being some surgeons fears may be founded on their or other experiences with radiation and cancer, and so we need to reassure them of the different context that the doses and experience with treating DD with radiation is a different kettle of fish completely.

Your references are excellent for this. It would be nice if they were in the main website.

Edited 08/01/16 17:22

08/02/16 01:01
Angetori 
08/02/16 01:01
Angetori 
Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

Thanks so much for sharing all that great information with me. It's encouraging.
I am supposed to hear from my Radiologist tomorrow and I will let you know what he said.
Again thanks.

08/02/16 01:46
nanshands 
08/02/16 01:46
nanshands 
Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

Angetori,

Your post caught my attention and I will be following what you learn from your doctor and how you proceed with your carpal tunnel.

My experience: I was diagnosed with mild CT prior to RT. The nerve testing they will do is great at determining the severity of your CT. I did not notice any changes with my CT after the first round of RT. But, definitely, initially had more pain and aggravation in my wrist after the second round. Frankly, it really scared me. The RT area was expanded in the second round and went too far down into the wrist. I became concerned permanent damage had occurred. Eventually the pain settled down and went away.

But, like you, I am hesitant to ever address CT surgery that might aggravate or reignite my DD.

RT has substantially slowed the progression of my DD in both of my hands, though only right hand treated. Personally I feel not addressing the DD to be of greater consequence if you are having rapid progression of nodules and formation of cords. Once they are there you are stuck with them. And mine are a far bigger problem than CT.

Nan

08/02/16 02:16
Angetori 
08/02/16 02:16
Angetori 
Re: In the middle of radiation treatments for DD and just got diagnosed with Carple Tunnel

Hi Nan
It sounds like you've been living with CT for quite some time Do you manage it with splinting and how do you keep it from not getting worse? Unfortunately that hand specialist made me feel like if I let my CT go and even with splinting, or getting a Cortizone shot , eventually there would be nerve damage in my hand . I am hoping he is wrong and I can manage it in the most conservative way. It's only about a month after my radiation and I did notice the CT kicked in a little harder after my first round was done.
After this experience I am afraid to go on with my second round of radiation on my hand. It's a bummer because I was so hopeful about it putting it at bay for a while After this ordeal maybe I'll manage my DD with NA or collogen shot.
I will wait and see what my radiologist says and keep you posted.
Thanks

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injections   Contracture   specialist   digital-palmar   nodules   diagnosed   conservative   surgery   radiotherapy   experience   anti-inflammatories   radiation   progression   Dupuytren   treatments   complications   splinting   radiologist   anti-inflammatory   radiotherapists