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Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?
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03/05/20 07:55
Jamba90 
03/05/20 07:55
Jamba90 
Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

Hi,

I was diagnosed with DD in my right hand with a .5 CM sized nodule under my ring finger. My timeline:

August 19 - Noticed and raised w/ GP. Told to wear gloves as i was doing weights and alot of pullups (maybe 100-150 / week)
October 19 - Saw a hand therapist who told me he thought i had DD.
December 19 - Ortho surgeon confirmed i had DD. Suggested i wait to see direction. also had a new, 1-2mm nodule by then and beginnings of a cord south of larger nodule. Significantly cut exercise schedule. Rarely do pullups now.
January 20 - began getting burning pains in right hand, shooting numbness up right arm, some burning sensation in left hand.
February 20 - went back to Ortho and started steroid injections w/ Triamcinolone. Following the 3X shot protocol direct in nodule. Also noticed cord starting north of nodule. Seems to be continuing post shot, but hard to say.

I'm wondering now if i should move to RT or continue the steroid shorts? I read here that if the Fibroblasts aren't active, then RT isn't helpful. So wondering if my steroid treatments have limited the effectiveness and value of moving to RT? So choices are:

1 - Continue steroid shots and see if they pause the disease
2- Stop steroids and do RT
3- Do both
4- Do nothing (i likely wouldn't do nothing and have decided to pursue early treatment)

Anyone have experience on mixing early treatment types?

Thanks,
Jamba

03/05/20 21:53
spanishbuddha 

Administrator

03/05/20 21:53
spanishbuddha 

Administrator

Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

Jamba90:
Hi,

I was diagnosed with DD in my right hand with a .5 CM sized nodule under my ring finger. My timeline:

August 19 - Noticed and raised w/ GP. Told to wear gloves as i was doing weights and alot of pullups (maybe 100-150 / week)
October 19 - Saw a hand therapist who told me he thought i had DD.
December 19 - Ortho surgeon confirmed i had DD. Suggested i wait to see direction. also had a new, 1-2mm nodule by then and beginnings of a cord south of larger nodule. Significantly cut exercise schedule. Rarely do pullups now.
January 20 - began getting burning pains in right hand, shooting numbness up right arm, some burning sensation in left hand.
February 20 - went back to Ortho and started steroid injections w/ Triamcinolone. Following the 3X shot protocol direct in nodule. Also noticed cord starting north of nodule. Seems to be continuing post shot, but hard to say.

I'm wondering now if i should move to RT or continue the steroid shorts? I read here that if the Fibroblasts aren't active, then RT isn't helpful. So wondering if my steroid treatments have limited the effectiveness and value of moving to RT? So choices are:

1 - Continue steroid shots and see if they pause the disease
2- Stop steroids and do RT
3- Do both
4- Do nothing (i likely wouldn't do nothing and have decided to pursue early treatment)

Anyone have experience on mixing early treatment types?

Thanks,
Jamba
Hi Jamba90

I too stopped the pull ups after DD diagnosis. I have not had steroid shots, but would argue they will help mainly with local inflammation and pain, and if you are starting to or currently developing cords, then it's a good indication that RT might be appropriate. I would accurately map your hands if possible, yourself, seek an appointment with a radiologist experienced in treating DD with RT, continue with the steroid shots, and use the time elapsed to gauge progression or not to help with the go/no-go decision with RT.

Best wishes SB

03/07/20 16:02
Jamba90 
03/07/20 16:02
Jamba90 
Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

Thanks, Buddha. Sound advice.

My hand surgeon recommended at the 1st appointment that I ‘wait and see’ and I regret that now. I think the 2 months that I waited allowed more diseased tissue to form and just made the disease harder to control. The proliferation of small nodules aren’t really injectable at this stage, but still likely producing fibroblasts that may one day trouble me. I have 1 big one and 3 tiny ones now that are more like skin bubbles.

His words to me as he was injecting my 2nd nodule of 2mm were ‘it’s a shot in the dark’. True, but not confidence inspiring.

The study that got me to try the steroid shots was this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292260/. I’ve exchanged emails with Dr. Ketchum. He began his steroid work as an intern.

Do you happen to know if anyone on the forum has experience with Triamcinolone v Cortisone shots?

Thanks,
Jamba

03/07/20 16:16
Jamba90 
03/07/20 16:16
Jamba90 
Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

Btw, the pull-up comment seems really interesting. I’m confused that the medical field seems to not recognize the unusual correlation between pulling exercises and DD. I asked my doc if that could trigger DD and he said no. I also read a good bit on the disorder and most articles say it’s not correlated to much beyond diabetes, smoking, family history, etc.

But when I read people’s stories, I frequently read about people who were doing weights, crew or something similar and now have DD.

It also seems to me that having this named Vikings disease after a seafaring people known for rowing would be a giveaway that pulling exercises are a significant trigger for those genetically predisposed.

Not sure what to do with that, but perhaps GP’s for those over 40 should be at least sensitized to the association. The literature isn’t there today. Or is it just me?

Jamba

03/08/20 10:28
spanishbuddha 

Administrator

03/08/20 10:28
spanishbuddha 

Administrator

Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

I don't know about cortisone v triamcinolone. But, there are quite a few published papers on the efficacy of triamcinolone for DD nodules. Search PubMed. Also, I'm fairly sure Dr Denkler in CA uses it when treating with NA, and fairly sure Dr Pess in NJ uses it for some presentations not ready for NA. Basing this on memory from people posting on FB. On this board people report mixed results with 'steroid' (whatever that means) injections.

03/08/20 10:31
spanishbuddha 

Administrator

03/08/20 10:31
spanishbuddha 

Administrator

Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

Jamba90:
Btw, the pull-up comment seems really interesting. I’m confused that the medical field seems to not recognize the unusual correlation between pulling exercises and DD. I asked my doc if that could trigger DD and he said no. I also read a good bit on the disorder and most articles say it’s not correlated to much beyond diabetes, smoking, family history, etc.

But when I read people’s stories, I frequently read about people who were doing weights, crew or something similar and now have DD.

It also seems to me that having this named Vikings disease after a seafaring people known for rowing would be a giveaway that pulling exercises are a significant trigger for those genetically predisposed.

Not sure what to do with that, but perhaps GP’s for those over 40 should be at least sensitized to the association. The literature isn’t there today. Or is it just me?

Jamba
Your read our section on trauma? https://www.dupuytren-online.info/dupuyt...ure_trauma.html

03/09/20 22:42
BRIANB 
03/09/20 22:42
BRIANB 
Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

Mine began right after trauma ...then moved to my other hand..not smoking ..diabetes etc..
I stopped doing pullups..wear gloves whenever vibration is involved including driving...and braces at night.
Our hands take a lot of abuse day in day out..perhaps we should treat them with more care..
IMO

03/14/20 06:18
Jamba90 
03/14/20 06:18
Jamba90 
Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

BrianB - Yet another pull-up guy. I wish I’d know the potential before jumping on that bar. Ha!

Buddha - thanks for the Trama link. Fascinating reading and I guess that all goes into the ‘potential causal’ factor bucket. While it may not be scientific, I think I’ll bug my son a bit less about pullups. ;-)

03/14/20 16:35
Jamba90 
03/14/20 16:35
Jamba90 
Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

BTW, I now also wear gloves religiously and also bought these: Weight Lifting Hooks - with Lifting Wrist Straps for Pull-ups, deadlifts, pull downs https://www.amazon.com/dp/B07KY6KY1C/ref...i_wsgBEbRJECPG7

They take some pressure off the hands, but I’m still kind of iffy and just got them last week. I used to do about 50 pullups 3x / week on weeks I got a full workout in. Some with a weight belt and 45 lbs hanging off. the weight belt is gone now both b/c of concern and atrophy.

I’m thinking I’ll only do pullups once a week from here and move to swimming, which I’m terrible at, but will provide the added benefit of cardio. The joy of dups!

03/14/20 21:57
spanishbuddha 

Administrator

03/14/20 21:57
spanishbuddha 

Administrator

Re: Is combining therapies (RT and Steroids) beneficial? When do you decide 1 hasn't worked?

Jamba90:
BTW, I now also wear gloves religiously and also bought these: Weight Lifting Hooks - with Lifting Wrist Straps for Pull-ups, deadlifts, pull downs https://www.amazon.com/dp/B07KY6KY1C/ref...i_wsgBEbRJECPG7

They take some pressure off the hands, but I’m still kind of iffy and just got them last week. I used to do about 50 pullups 3x / week on weeks I got a full workout in. Some with a weight belt and 45 lbs hanging off. the weight belt is gone now both b/c of concern and atrophy.

I’m thinking I’ll only do pullups once a week from here and move to swimming, which I’m terrible at, but will provide the added benefit of cardio. The joy of dups!
I tried those hooks, for deadlifts, but stopped with them. I just couldn't get on with them, but everyone is different. I now just use gloves, but I don't deadlift heavy weight, just a few reps to help with core. Worth trying all suggestions though to keep active. I use a bike and skipping for cardio.

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injections   effectiveness   wsgBEbRJECPG7   contractracture   disease   intra-lesional   therapies   discoloration   Significantly   beneficial   Steroids   religiously   depigmentation   Triamcinolone   Fibroblasts   steroid   dupuytren-online   pullups   combining   Lifting