Little finger DIP joint Dupuytren's | Dupuytren |

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Little finger DIP joint Dupuytren's
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noodles12 

noodles12 
Little finger DIP joint Dupuytren's

Hi all

Just diagnosed with Dupuytrens and curious to get some thoughts;
- 33yo male
- Presentation is a non-painful lump of tissue to the inner/underside of the DIP joint on my left little finger (Pictures attached)
- DIP joint almost immobile and contracted to ~35°. PIP joint mobile but unable to straighten itself beyond ~50° (I can force it back to about ~20° manually though). So total DIP+PIP joint contracture around ~85°. MCP joint appears unaffected
- No other DP symptoms / nodules that I can tell (A surgeon felt my hands as well and didn't seem to find anything)

Some articles I have read (https://pubmed.ncbi.nlm.nih.gov/31781455/, https://pubmed.ncbi.nlm.nih.gov/18092701/, and others) mention that isolated DIP joint Dupuytrens is not the most common presentation. Is there anything known about Dupuytrens in this area as compared to more typical presentation, or experiences people may have with surgery on this area?

My surgeon seems to suggest that it may be prudent to wait a bit to have surgery for a few reasons (lack of effect on my life so far, complications risk, likelihood of further development of Dupuytrens due to my younger age etc). I'm ok with this plan but it won't take much more contracture of this pinky before it will start to affect some things (like playing basketball, my main exercise), so I'm keen to learn more.

spanishbuddha 

Administrator


spanishbuddha 

Administrator

Re: Little finger DIP joint Dupuytren's

Hi noodles

Thanks for sharing those photos. Is there a palpable cord that is causing the joint contracture? I guess RA has been ruled out? If there is a cord I would see if NA is possible or open fasciotomy or other minimal surgical intervention to straighten the joint. Otherwise the longer joints are left in a contracted position, the harder it becomes to restore them completely as irreversible changes can occur. If thereafter there are further signs of DD, the possibility of RT in a limited area could be investigated even though you are quite young.

Best wishes SB

noodles12 

noodles12 
Re: Little finger DIP joint Dupuytren's

spanishbuddha:
Hi noodles

Thanks for sharing those photos. Is there a palpable cord that is causing the joint contracture? I guess RA has been ruled out? If there is a cord I would see if NA is possible or open fasciotomy or other minimal surgical intervention to straighten the joint. Otherwise the longer joints are left in a contracted position, the harder it becomes to restore them completely as irreversible changes can occur. If thereafter there are further signs of DD, the possibility of RT in a limited area could be investigated even though you are quite young.

Best wishes SB
As far as a 'cord' - I am not sure, it is not the clear visible cord you can see on most example pictures on the net - nothing on my palm as far as I can tell.

There is a clear lump on the inside of my little finger at the DIP joint. When I feel the inner side of the intermediate phalange bone further down on that finger, it does seem there is some thickened tissue and the finger is visibly thicker than my right (unaffected) pinky. I'm not sure if that counts as a cord, but I assume there is something going on there because the PIP joint is affected.

The surgeon didn't mention radiation therapy as an option. I'm not sure if the surgeon intended this, but the message I got from my consultation was if I want to do something with my finger I might as well do surgery with a skin graft - rationale being at least it's more likely to be a permanent fix (at least for this area of disease I currently have). The other treatment options were not discussed as much - she did mention some of them weren't suitable for my presentation of Dupuytrens.

spanishbuddha 

Administrator


spanishbuddha 

Administrator

Re: Little finger DIP joint Dupuytren's

I would get a second opinion. I'm not in a position say your current surgeon's opinion, diagnosis, or recommendation is wrong; just that I would get a second opinion, so you can weigh the balance between them and discuss it with them too. Ensure the second opinion is from someone who has extensive DD experience; not a plastic or ortho surgeon, but hand wrist specialist with a DD pedigree you can refer to.

Surgeons hardly ever know about, or agree with RT.

noodles12 

noodles12 
Re: Little finger DIP joint Dupuytren's

spanishbuddha:
I would get a second opinion. I'm not in a position say your current surgeon's opinion, diagnosis, or recommendation is wrong; just that I would get a second opinion, so you can weigh the balance between them and discuss it with them too. Ensure the second opinion is from someone who has extensive DD experience; not a plastic or ortho surgeon, but hand wrist specialist with a DD pedigree you can refer to.

Surgeons hardly ever know about, or agree with RT.
Thanks - the idea of a second opinion makes sense


Reading a little more, it seems that RT is not generally recommended for already bent fingers (https://www.dupuytren-online.info/radiation_therapy.html).

Is there reason to think it would be effective in my case where contracture has already progressed a decent amount? Or are you suggesting it more from the perspective of me being young and likely to develop further Dupuytrens nodules etc?

spanishbuddha 

Administrator


spanishbuddha 

Administrator

Re: Little finger DIP joint Dupuytren's

My suggestion for RT was for after your finger has been straightened, if there are new or continuing signs of progression. Surgery, like most trauma, can cause or trigger a flare or new or renewal of nodules and cords in people susceptible to DD.

noodles12 

noodles12 
Re: Little finger DIP joint Dupuytren's

spanishbuddha:
My suggestion for RT was for after your finger has been straightened, if there are new or continuing signs of progression. Surgery, like most trauma, can cause or trigger a flare or new or renewal of nodules and cords in people susceptible to DD.
I see, thanks

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