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What happens in the latter stages of DD
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01/12/2014 23:43
Rdevin 
01/12/2014 23:43
Rdevin 
What happens in the latter stages of DD

The DD in my right little finger has now progressed to about 100 deg but slowly over the last year adding just 10 deg. It causes no pain and apart from some few things I cannot do with it there is no real incapacitation.

What I would like to know is what happens if I leave it, will it continue to bend or will it stay around 100 deg, are there going to be complications around the affected area like skin problems or having the finger always bent will it cause problems in the joints in years to come.

Do people just live with a bent finger or do they always need to get it treated at some point? Cannot find much out about this stage.

I know there is a great deal of evidence to say that the sooner it is treated the better but for me the travel to Australia (or NZ) is time consuming and as my job is basically a 24/7 one where I may be called on duty at any moment it represents a logistical problem.

Any advice on the latter stages of DD and what to expect would be most welcome.

Thanks in advance.

Ramos

01/13/2014 00:15
callie 
01/13/2014 00:15
callie 
Re: What happens in the latter stages of DD

I had a 90 degree contracture of my little finger. I had surgery 12 years ago and the finger is still perfect. I do remember my surgeon saying that if I waited much longer the procedure would have to be done in two separate surgeries.

If left alone, your finger could continue contracting into your palm. Then amputation enters the picture. Or, your finger could stay in its present condition. Everyone is different and the disease is unpredictable. If it were me, I would have surgery at your stage, but just as the disease is different for people, there are different ideas on what should be done.

01/13/2014 08:00
spanishbuddha 

Administrator

01/13/2014 08:00
spanishbuddha 

Administrator

Re: What happens in the latter stages of DD

After a long period with a contracture, there can be other fibrotic, skin, or joint changes such that although surgery may be successful in removing the cords, the finger is not entirely straightened and loses function permanently. Or further surgery, not specific to DD is needed to restore function. The worse the contracture the greater the problem if left.

Edited 01/13/14 10:01

01/20/2014 21:27
GeneralTHC 
01/20/2014 21:27
GeneralTHC 
Re: What happens in the latter stages of DD

Why does amputation enter the picture? I mean, wouldn't it be possible to just cut the tendon or something like that if you're going to that extreme?

01/20/2014 21:49
spanishbuddha 

Administrator

01/20/2014 21:49
spanishbuddha 

Administrator

Re: What happens in the latter stages of DD

GeneralTHC:
Why does amputation enter the picture? I mean, wouldn't it be possible to just cut the tendon or something like that if you're going to that extreme?
A cord is not the tendon but a build up of collagen. The difficulty that can arise is the cord gets entangled with nerves and blood vessels so that removal or severing becomes a problem, and whatever happens is a useless finger because of other tendon or joint changes. If left in a tight contracture there can be fungal skin infection and so for some the finger may be best removed.

If you read this site you will see that NA, when the cord is indeed severed, is a viable treatment if the contracture is not too advanced or been left too long.

01/21/2014 02:34
GeneralTHC 
01/21/2014 02:34
GeneralTHC 
Re: What happens in the latter stages of DD

spanishbuddha:
GeneralTHC:
Why does amputation enter the picture? I mean, wouldn't it be possible to just cut the tendon or something like that if you're going to that extreme?
A cord is not the tendon but a build up of collagen. The difficulty that can arise is the cord gets entangled with nerves and blood vessels so that removal or severing becomes a problem, and whatever happens is a useless finger because of other tendon or joint changes. If left in a tight contracture there can be fungal skin infection and so for some the finger may be best removed.

If you read this site you will see that NA, when the cord is indeed severed, is a viable treatment if the contracture is not too advanced or been left too long.

But it grows over the tendon sheath and it keeps it from moving by pressure? Is it a tumour essentially adjacent to the tendon sheath made of collagen? It seems like a surgeon could scrape it out of there. Why not just straighten it out regardless of the pain before it gets to such a state where it gets entangled in everything? I feel like that's what's kept me from being severely affected. Does the tendon shorten after the contraction or is that what causes the contraction?

Sigh ... thanks for any answers. I'm just looking for information. I know I have this, and I'm going to be dealing with it the rest of my life. I just can't help but wonder if keeping it straight--wearing a splint when sleeping, for instance, might slow the progression.

01/21/2014 03:34
callie 
01/21/2014 03:34
callie 
Re: What happens in the latter stages of DD

I don't think there is anything that can "slow the progression" if the Dupuytren's is active. I think the opposite is mostly true. If you try to inhibit or restrain the Dupuytren's it can stimulate the growth/contracture.

You said, "It seems like a surgeon could scrape it out of there." That is what my surgeon did in my case. All of the diseased tissue was removed. My finger is perfect 12 years later. Just like the disease, not everyone has the same experience. Other procedures leave the diseased tissue in your hand/finger.

The tendons are affected over a period of time with being associated with the contracture. Often, the longer a finger is contracted the more influence on the tendons.

01/21/2014 08:07
spanishbuddha 

Administrator

01/21/2014 08:07
spanishbuddha 

Administrator

Re: What happens in the latter stages of DD

No, cords are not related in any way to tendons or tendon sheaths. There are other structures in the hand that it seems to be more associated with DD. It's a false appearance that cords follows lines of tendons, and in fact there is a theory about the direction of tension as to why cords develop this way. As callie says tendons suffer as a side effect due to lack of use.

In the UK the gold standard for treatment has been surgery for many years. Leave it alone until there is a contracture and then cut it out. For many this is successful. But there are risks and problems. A surgeon may not be able to identify all of the DD cells. The act of healing may promote new DD growth. The physio for recovery can be long. Other risks from surgery including infection, pain, nerve or other damage. The skill and experience of the surgeon seems to make all the difference. So, treatments that are less risky have been developed, including NA and now the use of the collagenase enzyme Xiaflex. But none of these treatments tackle the source of the problem, the unwanted creation of collagen, and so the nodules and cords may recur after treatment. In fact there are many sad user experiences on here of people who are convinced that these interventional treatments have caused their DD to flare up and become more active.

For early stages of growth whilst still active, there is the option of using RT to slow down or halt progression. Even this does not work for everyone and of course has its own risks.

There are studies of using splints, at night, to keep the hand and fingers straight, after surgery, NA or Xiaflex. I don't have the latest data, but what I recall is that the evidence speaks to whatever conclusion you desire. This may be wrong. I myself started using a night splint (after RT) but now don't bother.

Edited 01/21/14 10:17

01/21/2014 19:40
GeneralTHC 
01/21/2014 19:40
GeneralTHC 
Re: What happens in the latter stages of DD

I appreciate the information, spanishbuddah! I found that post to be really informative.

I've been reading this site quite a bit, and I'm wondering now if it's not DD affecting me but rather a prolapsed flexor tendon. I can't seem to find very much info about that, though. Everything comes up DD when I search for it.

Edited 01/21/14 21:49

01/21/2014 19:52
callie 
01/21/2014 19:52
callie 
Re: What happens in the latter stages of DD

Can you take your other hand and straighten the finger? If Dupuytren's you wouldn't be able to do that without major pain.

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