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How soon to start NA?
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08/17/2013 00:28
moondanc 
08/17/2013 00:28
moondanc 
How soon to start NA?

Even though it feels like I've had DD forever I continue to find out how much I don't know about the disease. Since my husband now has DD (he has a family history although I like to tease him that he "caught it" from me) in the palms of both hands and possibly LD lumps, I have some questions.

As far as I know, conventional wisdom is that you can't get NA until you start to have contractures. Although he doesn't yet have contractures, we can definitely feel the cords not only on their way up to his ring finger on both hands but he also has a cord going down from the nodules toward his wrist. Has anyone ever had this?

We know he's a candidate for RT and after my NA need to start figuring that out but my question is--is there a reason he couldn't have NA on the cords before they reach the MCP joint, before he starts getting contractures? There're definite palpable cords. He's scheduled to have a consult w/Dr. Pess when I have my NA but I wonder if we should ask the question about NA for him ahead of time.

Thanks,
Diane

08/17/2013 04:51
LubaM. 
08/17/2013 04:51
LubaM. 
Re: How soon to start NA?

Hi Diane,
Interesting questions...
I'm sure Dr. Pess can tell you for sure, but my understanding is also that you can't have NA until you have a contracture. Isn't the purpose of NA to cut the cord and straighten the finger? When you say your husband has DD in the palms of both hands and possibly LD lumps... does he have cords as well as nodules in the hands?

One thing is for sure, he would benefit from RT for the LD lumps, and in my opinion, the sooner the better. I have had good luck with RT, especially for my LD.

Again, best of luck to you with Dr. Pess and please let us know what his opinion is for your husband.
LubaM.

08/17/2013 05:29
wach 

Administrator

08/17/2013 05:29
wach 

Administrator

Re: How soon to start NA?

Diane, I believe that a cord running from a nodule into the palm and towards the wrist is a normal symptom. I have it, too.

Wolfgang

moondanc:
... Although he doesn't yet have contractures, we can definitely feel the cords not only on their way up to his ring finger on both hands but he also has a cord going down from the nodules toward his wrist. Has anyone ever had this?
...

08/17/2013 07:24
moondanc 
08/17/2013 07:24
moondanc 
Re: How soon to start NA?

wach:
Diane, I believe that a cord running from a nodule into the palm and towards the wrist is a normal symptom. I have it, too.

Wolfgang
moondanc:
... Although he doesn't yet have contractures, we can definitely feel the cords not only on their way up to his ring finger on both hands but he also has a cord going down from the nodules toward his wrist. Has anyone ever had this?
...

Just to be extra clear. The nodule is in the middle of his palm and there are two cords running from that nodule. One is going up toward his finger and one is going down toward his wrist. Seems weird to me because every one of my cords runs up from the nodule toward the fingers.

What happens with nodules that run down toward the wrist? What contracts? Do you get some sort of a weird contraction between the nodule and the wrist?

Thanks,
Diane

08/17/2013 07:48
moondanc 
08/17/2013 07:48
moondanc 
Re: How soon to start NA?

LubaM.:
Hi Diane,
Interesting questions...
I'm sure Dr. Pess can tell you for sure, but my understanding is also that you can't have NA until you have a contracture. Isn't the purpose of NA to cut the cord and straighten the finger? When you say your husband has DD in the palms of both hands and possibly LD lumps... does he have cords as well as nodules in the hands?

One thing is for sure, he would benefit from RT for the LD lumps, and in my opinion, the sooner the better. I have had good luck with RT, especially for my LD.

Again, best of luck to you with Dr. Pess and please let us know what his opinion is for your husband.
LubaM.
Hi Luba,
Yes, he does have cords as well as nodules. The cords are sneaking their way up toward his fingers but not quite enough for the fingers to start contracting yet. Yes, the purpose is to cut the cord and straighten the finger but why can't the cord be cut before the contracture starts? There must be a reason it isn't done.

It was only a week ago that he discovered what he thinks is an LD
nodule in his foot. We are going to let Dr. Press make that diagnosis. I also think he could benefit from RT in each of his hands. However, as soon as we get back from my NA procedure, he has to have surgery on his ankle and will be in a non-weight bearing cast for three months with at least 3 to 6 months of rehab to follow Then, we can tackle RT and whether Medicare will pay for it.

Plus, even though it seems like I've had DD forever I continue to form new nodules which itch and tingle and feel active. I hope that Dr. Pess will be able to give me an opinion about RT.

Thanks for your good wishes,

Diane

08/17/2013 08:19
wach 

Administrator

08/17/2013 08:19
wach 

Administrator

Re: How soon to start NA?

It's the fingers that are contracting, not the palm. A cord in the palm usually does not cause a problem.

Wolfgang

moondanc:
Just to be extra clear. The nodule is in the middle of his palm and there are two cords running from that nodule. One is going up toward his finger and one is going down toward his wrist. Seems weird to me because every one of my cords runs up from the nodule toward the fingers.

What happens with nodules that run down toward the wrist? What contracts? Do you get some sort of a weird contraction between the nodule and the wrist?

Thanks,
Diane

08/17/2013 13:47
LubaM. 
08/17/2013 13:47
LubaM. 
Re: How soon to start NA?

wach:
It's the fingers that are contracting, not the palm. A cord in the palm usually does not cause a problem.
Wolfgang
Wolfgang,
Can you please clarify this for me...how does a cord in the palm not cause problem/contracture? In each of my three NA's the only existing cord was in the palm and causing to pull on the small finger at the PIP joint. Of course...we are all so different with this weird disease.

08/18/2013 00:35
moondanc 
08/18/2013 00:35
moondanc 
Re: How soon to start NA?

wach:
It's the fingers that are contracting, not the palm. A cord in the palm usually does not cause a problem.

Wolfgang

Hi Wolfgang,
I know you know more about this disease than I-- and probably wish you didn't--but I have the same response as Luba. My DD started 25 years ago,nodules and a slowly advancing cord up my RH ring finger toward my MCP joint-- took 20 years to contacture. But then--almost all the nodules I had in my hands developed cords that started working their way up to my fingers and MCP joints. They've been dealt with in previous NA procedures.

Now, perhaps, I have what you are speaking of-- nodules that have devoloped BETWEEN the MCP and PIP and weird contractures where it's difficult to discern the cord. I understand your remark in this context.

However, my husbands case is the same as mine originally was. Nodules in him palm-- both hands, cords coming out of the nodules working their way up toward his ring finger. Hopefully a year or more before contracture-- BUT there's a palpable cord-- why can't this be cut, why does one have to wait for a finger contracture?

Thanks,
Diane

08/22/2013 14:39
wach 

Administrator

08/22/2013 14:39
wach 

Administrator

Re: How soon to start NA?

Diane,

the problem is that after the needle procedure you need to pull heavily on the cord to break it. The usual advice is to wait until you have 20 deg contracture and then intervene. A few docs will use NA earlier and try breaking the cord by hyperextending the finger. If you have no contracture at all pulling on the cord will be difficult. Even if you are able to break the cord, without prior contracture the open ends of the cord will stay so close together that they will likely grow together again.

Another option would be what good old Dupuytren had done: a knife fasciotomy. The skin is opended and the cord is cut with a surgical knife. You might even remove a segment of the cord to delay recurrence ("segmental fasciectomy"). But that's a major intervention, will cause scar tissue and might trigger Dupuytren's elsewhere. Personally I wouldn't do it but rather wait until I have a real issue with the cord.

Wolfgang

moondanc:
...
However, my husbands case is the same as mine originally was. Nodules in him palm-- both hands, cords coming out of the nodules working their way up toward his ring finger. Hopefully a year or more before contracture-- BUT there's a palpable cord-- why can't this be cut, why does one have to wait for a finger contracture?

Thanks,
Diane

08/22/2013 15:56
callie 
08/22/2013 15:56
callie 
Re: How soon to start NA?

While many people take offense/scoff to the "wait until contracture" that is often mentioned, there is valid reasoning. A primary reason is that often contraction does not reach a point of having any procedure done. Another good reason is that any procedure can trigger the advance of Dupuytren's. In my case surgery was the optimal procedure in which all of the diseased tissue was removed and there hasn't been any new development in the area.

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fasciectomy   development   although   contracture   contracting   moondanc   radiotherapy   nodules   contractures   hyperextending   straighten   then--almost   fingers   Wolfgang   understanding   procedure   intervention   recurrence   contracture--   contraction