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What is considered rapid progression?
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10/02/2018 21:59
Susan_Surdow 
10/02/2018 21:59
Susan_Surdow 
What is considered rapid progression?

I have been doing some online research and see 3 subtypes of Dupuytrens disease. I am trying to figure out if I am type 1 or type 2. What I can't find is what would be qualify as a "rapid progression". My case....I first noticed nodules Thanksgiving Day 2017 (November) at the age of 49. Currently, 10 months later, I have a 10 degree contracture of my left pinky at the second knuckle. Yes, there is family history. My maternal grandfather had 3 finger on his right hand with severe contractures. They used to call it "trigger finger" because he always looked like he was shooting a gun. My younger brother also has a significant contracture of his right ring finger. I am trying to decide if/when to start treatment and what my best options might be. I have a feeling treatment modality might be affected by how quickly contractures form.

10/03/2018 08:15
wach 

Administrator

10/03/2018 08:15
wach 

Administrator

Re: What is considered rapid progression?

Hi Susan,

welcome to our forum!

Regarding the Dupuytren subtypes, please explain what type 1 and 2 mean. If you are referring to stages of Dupuytren's https://www.dupuytren-online.info/dupuyt..._therapies.html then you are probably in stage N/1 or 1. Stage 2 would be an extension deficit bigger than 45 degrees.

Dupuytren contracture usually develops slowly, it might take 3-5 years to develop a contracture, many people with mild symptoms of Dupuytren's (nodules in the palm) never develop any contracture at all and need no treatment. If your finger contracted already within one year then I would consider it rapid progression. To slow down progression radiotherapy might be a means. I would not have the full hand irradiated but only the nodule/cord that you have (with some margin around). This allows to treat other fingers later should a new nodule develop there. If you want no radiotherapy you could either wear a night splint https://www.dupuytren-online.info/dupuyt...-splinting.html to avoid further contracture or try needle fasciotomy (NA). Some doctors are already treating fingers with small extension deficits.

If "trigger finger" was just a nick name for your grandfather's condition and bis fingers were bent permanantly, he probably suffered from Dupuytren's. But "trigger finger" is also a name for a different disease. A trigger finger is temporarily fixed in a bent position. This happens instantly and can go away again quickly as well. Dupuytren's is (usually) slowly developing and results in a permanent extension deficit, i.e. the inability to fully stretch the affected finger.

Should your brother consider treatment of his finger he might explore the minimally invasive NA https://www.dupuytren-online.info/needle_aponeurotomy.html and collagenase injection https://www.dupuytren-online.info/dupuytren_collagenase.html.

BTW, where do you live? Unfortunately not all treatments are available everywhere.

Wolfgang

10/11/2018 19:44
Susan_Surdow 
10/11/2018 19:44
Susan_Surdow 
Re: What is considered rapid progression?

By types of Dupuytren's disease, I mean there are 3 different types according to the Dupuytren's Foundation. https://dupuytrens.org/three-types-of-dupuytren-disease/

My grandfather did have Dupuytren's disease not trigger finger. His kids called it a trigger finger because he had contractures of last 3 digits on his right hand.

I live in the NY metropolitan/Long Island area and am a little concerned about this minor contracture because it developed in under a year from discovery of the first nodule.. So I am wondering if that is considered "rapid progression". I have also recently found a nodule on my other palm and slight roping of the corresponding tendon on that hand.

Edited 10/11/18 22:46

11/22/2018 22:42
Prof.Seegenschmiedt 
11/22/2018 22:42
Prof.Seegenschmiedt 

Re: What is considered rapid progression?

From the perspective of radiation therapy "rapid progression" is considered when the following changes of symptoms / signs occur and progress within a period of 3 - 6 months:

(1) NODULES:
Change (= increase) of number of detected nodules; increase of size of nodules; involvement of other finger rays than the previously involved finger ray; change of the consistency of the nodules (soft - medium - hard)

(2) CORDS:
Development of a first cord or new cords; increase of the length of the cord

(3) FINGER INVOLVEMENT:
Spread of new nodules and cords to the fingers

(4) CHANGE OF HAND SURFACE PROFILE:
Development of new wrinkles, folds, pit holes etc.

(5) CHANGE OF HAND & FINGER FUNCTION:
Increased tension or pressure feeling; increase of pain; itching or other sensations; developing of finger "bending"; unable to perform the "Table Top Test"

(6) SUBJECTIVE EVALUATION:
Evaluation and changes of the above symptoms may be additionally and subjectively graded on a scale of 1 - 10.

(7) OBJECTIVE EVALUATION:
Take photographs in defined intervals (e.g. evry 3 months) under standard light conditions and mark your palpated or observed changes of the hand palm on the skin with a marker pin. Compare the photographs.

The evaluation should be repeated about every months, thus, that changes may be recorded for about 3 time intervals over a period of at least 3 months.

Patients should receive radiotherapy only if progression - using the above criteria - has been documented for at least 3 months; I personally prefer even an observation period of 6 months, as a "spontaneous stand still" may be possible.
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With gratitude for all affected patients & medical colleagues who help to advance patient care.Prof. S.

Edited 11/23/18 08:18

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