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Hi, new to the forum please help!!
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10/06/2010 20:31
shadowfax 
10/06/2010 20:31
shadowfax 
Hi, new to the forum please help!!

Hi I'm Jamie a 29 years old male and I work as a mechanical service engineer. I have played the guitar since I was 10 and I think this may be related but I am unsure.

So I stopped playing guitar regularly about 2 years ago as I have young children which take up most of my time, I recently picked up my acoustic and started playing again seriously and found that the morning after practising I had a stifness in my middle finger of my fretting hand (left) usually worst the morning after playing. I'd never had this before and initially put it down to old age or playing to much without warming up/easing myself back into it.
I also noticed that it ached if put under certain pressures like when I pulled the finger or made a tight fist.
Anyway after a couple of months I decided to go to the doctors and about this time I noticed that sometimes I couldn't properly straighten the middle finger without forcing it. So my Doctor instantly told me that it was DD and told me to rub iboprufen gel into it, but I have looked into it and I cannot see or feel any nodules in my hand at all.
It also, from what I've read here, seems unusual that it would start in my middle finger as most cases seem to be in the ring or little fingers.
Since the initial month or so of it really being stiff it seems to have become less problematic at work and I very nearly cancelled my drs appointment but as I had to wait for 2 weeks for a meeting with my GP I thought I'd better go.
Anyway as you can guess, I'm not convinced of the diagnosis, but I thought I'd ask some experts on this forum to see if anyone knows of similar hand issues that can give stifness and slight bending of a finger without nodules. This symptoms are pretty much non existent if I warm up my hands properly.

Any help would be much appreciated.

Many thanks

Jamie.

10/07/2010 00:03
tam1 
10/07/2010 00:03
tam1 
Re: Hi, new to the forum please help!!

Jamie, I wonder if you have an actual Dupuytren's contracture or whether you are experiencing tenosynovitis or trigger finger. Last year I developed Dupuytren's in both hands but also was diagnosed with trigger finger in my index finger. I learned from my hand surgeon and my hand therapist that although trigger finger (stenosing tenosynovitis) usually involves a locking or catching of the finger at the middle joint, in some people the finger just becomes very stiff, painful and slightly bent, without the complete locking or clicking action--and there can be swelling in the finger as well. Trigger finger is a form of tenosynovitis, which is an inflammation of the tendon sheath that the finger tendon moves within. Of course, it can occur in people without Dupuytren's, and there are a number of reasons it develops, including overuse and repetitive motions. My finger was stiff, swollen, hard to straighten, and very painful whenever I used it. It was most painful in the morning and at night, and although I could straighten it somewhat by massaging it, the finger always returned to a slightly bent position. I tried a cortisone shot to relieve the inflammation in the tendon sheath, but had no luck and finally underwent minor surgery to correct the problem. In some people, trigger finger and tenosynovitis will disappear eventually on their own, without surgery or cortisone shots.

Has a hand surgeon looked at your finger?

10/07/2010 12:37
lori 
10/07/2010 12:37
lori 
Re: Hi, new to the forum please help!!

Jamie,

When I developed DD it started with me being a little clumsy. I was dropping things and I blew it off to to old age (53 years old)and arthritis. I noticed a stiffness in my middle finger and once again thought arthritis. That was in the summer of 2008. By late fall or December I had a sore spot in the palm of my right hand. Didn't think too much of it and figured I had an internal bruise or callus coming because I had been working quite a bit in my vegetable bed. Well by January I had a small knot in my palm, once again confirmed in my mind a callus was developing. But... I had been having intense pain in that entire arm, palm and hand. That finally took me to the doctor who did not have a clue as to what I had. She referred me to a hand surgeon. By the time I was able to get into see him in March I had a cord, a much larger nodule, dimpling, puckering, and a slight bend/drawing in of the middle finger. It all happend rather quickly. Once I was diagnosed with DD, I was able to go back in my mind and realize the clumsiness, dropping of things, difficulty slicing, and gripping were all the first indications that something was amiss. I recommend keeping a log of your symptoms and when they develop. Time disappears and changes when you try to go back and remember. I agree that you should see a hand surgeon for diagnosis. My hand surgeon said there were no treatments until severe contraction and then surgery was the only option. Obviously not true. I had RT last year and am now in regression and have been for 14 -15 months. I go back for my last check up in November. Nothing new has developed and in fact the nodule has completely disappeared.

Which reminds me... Wolfgang or anyone who knows. Why would the nodule disappear and the cord still remain? Are they not made of the same material?


Lori

10/07/2010 14:11
callie 
10/07/2010 14:11
callie 
Re: Hi, new to the forum please help!!

lori,

Good question. I have had nodules disappear on their own, also. And, it was without any treatment. My father has had nodules in his hand for 30 years that never progressed. He has not ever develop Dupuytren's cords.

Edited 10/07/10 17:12

10/07/2010 14:26
tam1 
10/07/2010 14:26
tam1 
Re: Hi, new to the forum please help!!

Hi, all--

Since Jamie has brought up the issue of finger stiffness, I'd like to ask whether this is an ongoing issue for some people with Dupuytren's. I've read messages on the Forum that discussed stiffness in the morning or after waking from a nap, for example, and I wonder how common it is to experience finger stiffness and/or pain in the fingers, even when no contracture is present.

I also strongly agree with Lori that hand surgeons are the ones to consult for DD and any type of hand problem. Most primary care doctors know little about DD or tendon problems in the fingers.

Tammy

10/07/2010 17:18
shadowfax 
10/07/2010 17:18
shadowfax 
Re: Hi, new to the forum please help!!

Wow! Thanks for the replys, I will try and locate a hand specialist, I'm not sure if I can do that through the NHS or not, I may have to go private.

It seems weird to me that I have no nodules lumps or swelling on that finger. The feeling is similar to an injury I had a few times when I was at school. I used to play for the basketball team and you occaisionally get the ball stub you on the end of your finger which is really painful. For days afterwards the finger itself feels a little tender and stiff, this is kind of what it feels like, more like a sprained muscle or something.

So with early stages of contracture is it impossible to straighten the finger alone? I can straighten mine but it just seems to feel a little stiff.

Thanks again for the replies guys, it's been a lot of help.

10/08/2010 11:45
lori 
10/08/2010 11:45
lori 
Re: Hi, new to the forum please help!!

In answer to the question about finger stiffness with DD. My middle finger is stiff in the mornings. It feels like the skin is too tight for the finger when I bend it. If I bend the fingers in both hands I don't feel anything except for that finger. I can touch the palm of my hand with all fingers and not feel a twinge. With that middle finger I can touch the palm and flatten it, but it is uncomfortable and borders on slight pain. As the day goes on it loosens up. If I clinch that hand into a fist at night, I will wake up as I open the hand because of the pain.

Lori

10/10/2010 03:17
flojo 
10/10/2010 03:17
flojo 
Re: Hi, new to the forum please help!!

A feeling of tightness was and continues to be a symptom for me. Tightness was across the palm from the pinky to my thumb. After treatments, NA and RT, the tightness lessened but hasn't gone away fully. I don't really expect it to, but I if I can keep it from progressing, I'll be happy. There were also improvements in span across my hand, the tingly/crawly feelings basically gone, soft and/or reduced nodules, etc.
Better is good, even if some symptoms still exist.
Just know that this is a weird disease, and every hand is different.

10/10/2010 15:32
wach 

Administrator

10/10/2010 15:32
wach 

Administrator

Why cords don't vanish after RT

Lori, it depends a little on the stage of the disease but growing nodules contain many myofibroblasts, those are cells that are also involved in wound healing and which are responding well to RT. Cords are essentially made of collagen which does not respond to RT. But, if I understand it correctly, growing cords still have a myofibroblasts core, so they might slow down growth after RT but won't vanish.

BTW, this is vice versa to collagenase: collagenase is expected to helps on cords (dissolves collagen) but not so much on nodules.

Wolfgang

lori:
...
Which reminds me... Wolfgang or anyone who knows. Why would the nodule disappear and the cord still remain? Are they not made of the same material?


Lori


Edited 10/10/10 18:33

10/10/2010 15:40
LubaM. 
10/10/2010 15:40
LubaM. 
Re: Hi, new to the forum please help!!

Jamie,

This disease is so "weird' that it presents itself so different from person to person, and even from hand to hand in one individual.

In my case DD started on my right hand, pinkie finger...the finger started to bend at the PIP joint (middle knuckle) without anything happening in the palm. After it started to bend, I developed a cord going from the middle of the palm to the pinkie, but even that cord is not visible as it is deeper within the palm. Most of the hand is flat, there are no nodules.... there is also two small, thin cords in the web of the hand pulling the thumb a bit in, but the thumb is functional and not affected. I've had NA twice on the pinkie, four years apart...and the NA only lasted about six months each time and is now again bent at about 45-50 degrees... I also have a contracture on the DIP joint of the same pinkie that is going up at the last joint...the finger looks like a reversed "Z".

My right hand lays flat, has four totally functional fingers and a "messed up" bent pinkie that is hard to correct.

On my left hand I have multiple nodules, dimples but no cords and no contracted fingers. I had RT in November '09 and it stopped the itching and burning, the nodules I had are much smaller and those that remain are definitely softer. For me RT was a good choice for this hand as it stopped the progression of the disease. (I also had successful RT for my left foot at the same time).

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nodules   inflammation   without   disappear   contracture   myofibroblasts   surgeon   problematic   improvements   started   occaisionally   developed   uncomfortable   Dupuytren   stiffness   fingers   tenosynovitis   straighten   experiencing   collagenase