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Steroid injection
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05/22/09 23:31
francois

not registered

05/22/09 23:31
francois

not registered

Steroid injection

Are corticosteroid injection to the nodule effective to slow the progression of the disease? Is it worth the side effects? I could get an injection in 5 days but I don't know if I should go for it. I just developped a nodule under the rigth pinkie. I'm only 31. Rock climbing is to blame. I know a bunch of young climbers that have the desease. Thanks for your awnsers, Francois.

05/24/09 09:23
newman 
05/24/09 09:23
newman 

Re: Steroid injection

Hi Australia Calling Go to the left margin of the web page- Click Personal Experiences scroll down to Experience with steriods- Click on words-"The Web Page"and take a look at the pictures. Regards

11/07/15 09:30
derekbrian 
11/07/15 09:30
derekbrian 
Re: Steroid injection

I had my left shoulder pain and the pain was coming upto my left hand and it was such a severe pain that I couln't able to sleep on a bed. I had passed my nights while sitting on bed or chair. Problem was due to pressing of nerve under left shoulder bone. Doctor advised for MRI. For first five days I was on simple medicines and when there was no improvement he prescribed medicine of 5 days more consisting of steroid tablets to be taken twice in a day along with exercise from PT. Thereafter my condition started getting improved and thereafter with in 10 days I got fit.

06/27/22 22:38
Dougster 
06/27/22 22:38
Dougster 
Re: Steroid injection

Here’s my “Dupuytren’s Tale of Woe and Intrigue”, but first a summary...
For early intervention, before the nodules develop too far, find a rheumatologist who will provide the treatment per the following webpage (last half), but use Depo Medrol (methylprednisolone acetate) 40mg total, as a substitute for Kenalog 40:
AAFP Journal, “Dupuytren's Disease: Diagnosis and Treatment”
https://www.aafp.org/pubs/afp/issues/2007/0701/p86.html
This was a simple, low risk treatment that worked wonderfully and completely exceeded all my expectations.

And now the TL;DR version...
I am a white male, 69 years old, who lives in the United States. On August 1, 2019, I discovered a nodule in the palm of my left hand. After doing some research on the internet, I assumed it was Dupuytren’s Contracture caused by using a pneumatic hammer some months earlier to chip away at some concrete. I scheduled an appointment with a hand surgeon a couple of days after the discovery and saw the doctor about three weeks later. She confirmed that it was Dupuytren’s and recommended a wait and see approach. The hand surgeon stated that she can do surgery once the contracture had established itself.
I made another appointment with another hand surgeon roughly 5 weeks later, September 2019. At that appointment, I requested a steroid shot. He thought the idea was “lame” but figured it was low risk and was a good sport about it. He gave me a mixed injection of 5 mg of Kenalog 10 and Marcaine. This seem to do the trick for a few months. Please note that this injection was not what is recommended by the AAFP Journal mentioned in the summary above.
By September 2020, I visited hand surgeon #3. By this time the original nodule had grown back; the cord of my middle finger had grown longer in the proximal direction. A smaller nodule now appeared in the palm in line with my ring finger, again on my left hand. This hand surgeon was also a good sport when I requested a steroid injection, but he did not use the procedure as published by AAFP. Instead he mixed Kenalog 40 and Lidocaine into a single injection, roughly 10 mg of Kenalog 40 in the old nodule and incompletely in the new nodule. This again helped for a while but I could tell the Dupuytren’s was coming back after a couple of months.
I saw hand specialist #4 in May 2021. I explained that I had Dupuytren’s Contracture and I was interested in a steroid injection. His response was “we don’t chase nodules”. That office visit lasted maybe 2 minutes, perhaps less.
I saw hand surgeon #5 in August 2021. He agreed to a steroid injection, but I had to reschedule to have the procedure done. It was October 2021 by the time I finally was able to see him again. At this point, the doctor didn’t want to do the steroid shot, but rather a needle aponeurotomy because the nodules had grown. I refused and left.
I scheduled an appointment with a doctor who specializes in family medicine. This was at the end of October 2021. He said that he’s treated this affliction before, so I showed him the AAFP Journal procedure. He hadn’t seen this but was appreciative. He substituted Kenalog 40 with Depo Medrol because it is longer lasting. He used a total 40 mg of Depo Medrol. Otherwise it was exactly as described in the AAFP Journal. By this time the nodules had grown significantly, with a cord aligned with my index finger, and two cords that had grown together aligned with my ring and pinky fingers. I could still keep my palm flat on a table, but clearly the disease had progressed significantly.
My hand felt it had gone through a meat grinder for a couple of days after the procedure, because it had sustained roughly a dozen injections or maybe more. Lidocaine was injected separately from the Depo Medrol. After a week, my hand felt much better, and after a couple of weeks, my hand felt complete pain and ache free, which hadn’t been the case for a couple of years. The nodules proceeded to shrink. The two cords which had grown together had separated. On the whole, the cords shrank 50% to 70%.
It has been 8 months since my last treatment, and there is no indication of active Dupuytren’s. I consider my last treatment a raging success.
For anyone who has read this far, I firmly believe that early intervention of Dupuytren’s is possible, if you get the right doctor and right treatment plan. Based on my experience, don’t go to a hand surgeon. Big mistake! Insist on using the treatment as spelled out by the AAFP Journal, with the possible exception of using Depo Medrol instead of Kenalog.
There’s lots of buzz regarding a trial injecting Humira (adalimumab) into nodules. See the following webpage, “Anti-tumour necrosis factor therapy for early-stage Dupuytren's disease (RIDD): a phase 2b, randomised, double-blind, placebo-controlled trial”
[url=https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913]https://www.thela

Edited 07/26/22 18:41

06/28/22 07:59
wach 

Administrator

06/28/22 07:59
wach 

Administrator

Re: Steroid injection

Hi Dougster,

thank you very much for your detailed report! Maybe you could write an update after 6 - 12 months? It would be interesting to see how lasting the effect of injecting Depo Medrol (methylprednisolone acetate) is. Did you observe any other side effects, besides those described in your post? General side effects are e.g. listed on https://www.rxlist.com/depo-medrol-drug.htm#warnings .

Do you know how much Medrol was injected?

Caution might be advised if corticosteroids are injected repeatedly https://www.researchgate.net/publication...nt_of_Dupuytren's_contracture/link/57db2bdc08ae4e6f1843955e/download and I presume that is also valid for Medrol.

Wolfgang

06/28/22 09:08
spanishbuddha 

Administrator

06/28/22 09:08
spanishbuddha 

Administrator

Re: Steroid injection

Dr Pess in NJ uses Triamcinolone (Kenalog) injections under some circumstances, to ease pain and inflammation of sore nodules. There are a few FB posts of patients happy with the immediate results. There are counter reports of it not helping at all. Maybe Medrol is more potent for DD.

06/28/22 17:16
Dougster 
06/28/22 17:16
Dougster 
Re: Steroid injection

"Dupuytren's Tale of Woe and Intrigue", continued
- My hand was injected with a total of 40mg of Depo Medrol using the procedure published by the AAFP Journal.
- I had mild side effects. A dryness to the treated hand started a week after treatment and continued for two weeks. I applied hand lotion to the affected hand during that time.

I didn't mention this before, but I had started to develop what I believe to be Ledderhose disease in one foot. After treatment of my hand, it was stopped dead in its tracks. It hasn't bothered me since.

Edited 06/28/22 18:04

09/05/22 02:12
gitfiddle 
09/05/22 02:12
gitfiddle 
Re: Steroid injection

I'm 72 and have had smoldering Dupuytren's for many years. Being a physician, I have read every scientific article published on the disease for the past 30 years. I also searched the forums and any other source for patients' experiences with various therapies and doctors.

My conclusions were similar to Dougster's: start with the least invasive options to buy time, and move up the list when those fail. In order of least to most complications these are: steroid injections, radiation, needle aponeurotomy, Xiaflex, and surgery. Steroids and radiation address the early stages (pain and nodules). Once contractures occur, these treatments will have no effect, and then NA, Xiaflex and eventually open surgery become the treatment options.

I had steroid injections by Keith Denkler in San Francisco for growing and painful nodule and tightness in both hands. I chose him because of the many positive reports on the Dupuytren's forums, and he certainly knew what he was doing. He chilled my hands with a cold pack, injected a little lidocaine around each nodule, and then injected Kenalog into each nodule with a 30 gauge needle. Virtually no pain during or after, and we spent the next couple days sightseeing and hiking.

The nodules shrank and were not tender for 3 years. Then, as Dupuytren's is likely to do, it reactivated with development of a painless cord and contracture of the small finger. At this stage splinting alone will not straighten the finger. When I could no longer put my hand in my pocket or play the guitar and piano, I had needle aponeurotomy with a local hand surgeon who is intimately familiar with the location of nerves, tendons and vessels which must be avoided. He also injected Kenalog along the cord after straightening the finger to inhibit recurrence. Again, virtually painless both during the procedure and since. My finger is perfectly straight and fully functional, although it's been only six weeks. I wear a night splint to maintain the correction, hopefully for months or years. I'll do NA again if the disease progresses, as it often does.

For future growing painful nodules alone I might consider radiation, if I can find a radiation oncologist in the US with any experience; most of the expertise seems to reside in Europe.

09/05/22 07:59
wach 

Administrator

09/05/22 07:59
wach 

Administrator

Re: Steroid injection

Hi gitfiddle, thank you for your detailed report and advice! In my view it's very much to the point and is very helpful to decide what to do next.If you are looking for an RT expert you might check those listed on our website
https://www.dupuytren-online.info/radiotherapy_clinics.html .

Wolfgang

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nodules   aponeurotomy   Contracture   depo-medrol-drug   methylprednisolone   Steroid   procedure   placebo-controlled   “Dupuytren’s   Dupuytren   treatment   Kenalog   corticosteroids   injection   Dupuytren’s   PIIS2665-9913]https   rheumatologist   57db2bdc08ae4e6f1843955e   dupuytren-online   “Anti-tumour