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What is considered "aggressive", "average", or "slow" progression?
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07/18/19 01:53
gmb5127 
07/18/19 01:53
gmb5127 
What is considered "aggressive", "average", or "slow" progression?

Hi, I'm a 27 year old active male. Not sure if I have Dupuytren's yet, but I have an appointment scheduled in a little over a month, so we'll see. Regardless, about 20 months ago I found a painless (besides a little tenderness after weightlifting) bump on the palm of my hand below the pinky (also happened to get sick that night, I think that is just a coincidence though). Since then, what appears to be a cord has formed and there are small dimples in the one area when I flex back my pinky (attached) and it is easy to feel. Still no contracture, just feel a little bit of a pull when I try to extend it all the way.

I've read that Dupuytren's could be more aggressive because of my age (reading this forum has convinced me that it could also be slow, who knows). So, I'm curious, what is considered "aggressive", "average", or "slow" progression of Dupuytren's? And, can the pace change over time?

Thanks,
Greg

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07/18/19 19:27
spanishbuddha 

Administrator

07/18/19 19:27
spanishbuddha 

Administrator

Re: What is considered "aggressive", "average", or "slow" progression?

Hi Greg

I’m not aware of any formal or universally agreed definitions for these terms. Having said that, since you first noticed something 20 months ago, and now have possible signs slight skin dimpling and a possible cord, I would hardly say your case is aggressive. The appearance in the photo could be DD but let’s leave it to the professionals to confirm.

I had a sore nodule appear overnight, others report appearance of a cord to contracture over weeks or less than 3 months, often accompanied by pain or cramps, tingling, pins and needles, etc, I would call that aggressive. But most cases, the majority, develop oh so slowly over years, and often stall with no apparent ongoing progression although the changes might be subtle. In younger people these years may be accelerated into months, but even then it can slow down or stall.

I realise this might not helpful, but ProfsS views to treat or not might be helpful further reading https://www.dupuytren-online.info/Forum_...1559373063.html.

I would say protect your hands a bit, a bit more than you do so far, although some people say push through and say it makes no difference. I’m still bring unhelpful, but I protect my hands as there are cohort links associated with trauma and some sports.

Best wishes SB

07/22/19 01:13
gmb5127 
07/22/19 01:13
gmb5127 
Re: What is considered "aggressive", "average", or "slow" progression?

I appreciate the info! My hands have definitely been tingling, but my doctor thought it was just symptoms from minor carpal tunnel since I'm on the computer all day for work.

For hand protection, does that just mean from trauma? What about trying to strengthen them or use them for let's say catching a Frisbee?

Also, is there a verdict on whether or not stretching is good or bad? Or is this another example of no rule? I've read about splints at night, but it seems like they may just be for post-surgery or other procedures?

07/22/19 08:09
spanishbuddha 

Administrator

07/22/19 08:09
spanishbuddha 

Administrator

Re: What is considered "aggressive", "average", or "slow" progression?

gmb5127:
I appreciate the info! My hands have definitely been tingling, but my doctor thought it was just symptoms from minor carpal tunnel since I'm on the computer all day for work.

For hand protection, does that just mean from trauma? What about trying to strengthen them or use them for let's say catching a Frisbee?

Also, is there a verdict on whether or not stretching is good or bad? Or is this another example of no rule? I've read about splints at night, but it seems like they may just be for post-surgery or other procedures?
I don’t think there’s a generally agreed rule, I gently stretch my hands for piano and gently strengthen them with small weights for tennis and by doing piano exercises. I also gently massage them, whereas hard or cross friction massage is considered a no-no. I think excessive stretching is considered bad, also splinting as a prevention is unknown and even after treatment for contracture the juries out https://www.dupuytren-online.info/dupuyt...-splinting.html, although most people posting on here say it benefits them post treatment.

07/23/19 01:41
gmb5127 
07/23/19 01:41
gmb5127 
Re: What is considered "aggressive", "average", or "slow" progression?

Recently read a lot of posts on this page about the splints and it seems like the only "conclusive" statements I can come up with are:
1) Stretching or splinting may cause damage which may result in accelerated contracture.
2) Stretching or splinting may reduce contracture for a time

Almost seems like an optimization problem where there is a certain amount of splinting time where the reducing contracture effect equals the accelerated contracture effect (i.e., wearing each night while sleeping). Which could explain why experts are split on the issue and why the feet don't typically have contracture? I guess the rates for each could also be different for each person as well. Thoughts?

Regardless, thanks again for the info and for entertaining my thoughts!
Greg

07/23/19 08:15
Stefan_K. 
07/23/19 08:15
Stefan_K. 

Re: What is considered "aggressive", "average", or "slow" progression?

Hi Greg. What is your source for "'splinting may cause damage which may result in accelerated
contracture."? Usually the idea of splinting, especially with splint gloves worn at night, is to prevent the hand from making a fist during sleep which favours permanent curling of fingers with cords which pull on them. The splint should not put force on the fingers and stiffen them. Such a splint could not possibly cause trauma and make things worse. In which cases they are really effective over time remains to be established. I have had good results with mine for four years, but I have also had RT. I believe that without the glove my pinky would be bent again.

Stef

[57, Dupuytren diagnosis 2006, RH contracture and PNF/NA 2014, radiotherapy RH 2015, LH 2017 & 2018, night splint glove RH since 2015]

07/23/19 19:21
gmb5127 
07/23/19 19:21
gmb5127 
Re: What is considered "aggressive", "average", or "slow" progression?

Stefan_K.:
Hi Greg. What is your source for "'splinting may cause damage which may result in accelerated
contracture."? Usually the idea of splinting, especially with splint gloves worn at night, is to prevent the hand from making a fist during sleep which favours permanent curling of fingers with cords which pull on them. The splint should not put force on the fingers and stiffen them. Such a splint could not possibly cause trauma and make things worse. In which cases they are really effective over time remains to be established. I have had good results with mine for four years, but I have also had RT. I believe that without the glove my pinky would be bent again.

Stef

[57, Dupuytren diagnosis 2006, RH contracture and PNF/NA 2014, radiotherapy RH 2015, LH 2017 & 2018, night splint glove RH since 2015]

Hi Stefan, I meant to make the "may" imply that nothing is known for certain. However, the reference I was using for that idea is here:
http://dupuytrenfoundation.blogspot.com/2010/03/
My interpretation is that any resisting of the contracture could increase the pull of the contracture afterwards. Even though the splint may not stretch, my assumption is that at some point over night it is resisting the contracture to some extent (may not be true). Either way, my point I guess is that splinting being beneficial and harmful don't necessarily have to be mutually exclusive. They could both be true, just splinting overnight still has a net benefit.

Or everything I'm saying could just be nonsense haha, I'm trying to figure out if I'd want to splint before I get any contracture or do nothing for now (assuming I get a positive diagnosis in a month).

Greg

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