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Looking for advice/comments please
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11/14/2022 10:59
Louise1234 
11/14/2022 10:59
Louise1234 
Looking for advice/comments please

Hello! I am a 64 female living in the UK. I am confused and upset by my diagnosis. This is what has happened as I see it and I know the first bit might sound weird. Anyway, I was stung by a bee on the underside of my little finger, in between the knuckle and the middle joint just over 2 years ago. It hurt so much and would not stop itching. It couldn't stop scratching it. Eventually I noticed a small hard lump had formed under the skin, and I thought it was just the sting forming a scar. Anyway, over the course of the last 2 years, the lump grew and over the last maybe 6 months to a year, the little finger started to bend. It is at maybe 30-40 degree. It's only the middle joint that is affected. There is no bend from the knuckle.

I play the piano and this has affected my span as I can now only just stretch an active. I went to see my GP and he examined my hand. He wasn't very concerned and said there was (his words) this thing called Dupuytrens, which it couldn't be since there were no nodules, or swellings in my hand, or anywhere apart from this lump in my finger, which he thought felt like scar tissue. He said a surgeon would easily be able to just free this, and it would straighten my finger.

I was referred to an orthopaedic surgeon, and to my great surprise, he said it was Dupuytrens because he said he could feel a cord in between the knuckle and middle joint. I have no family history of it - both parents in their 90s know of nobody in the family. who had it. No smoking/obesidy/alcohol abuse etc. He kept asking if I really wanted anything done, since the lump is not hurting in any way, and he offered me surgery on my finger, which would involve general anaesthetic, a zig zag incision from the knuckle joint to just over the middle point. He then said it would take weeks of my hand being in a bandage, then possibly splints, physiotherapy, and it might not even straighten out my finger. In short, although he offered me the treatment, it didn't seem urgent to him.

I hadn't investigated Dupuytrens because my GP said it wasn't, so I didn't then know of any other procedures, but I wonder why he didn't offer my NA? I came to the conclusion that maybe it was just because he doesn't personally do it? Anyway, I have written to my GP and requested he ask if NA could be appropriate for me, or if there is anyone the consultant knows of who could perform it. I'm waiting to hear.

I don't understand how I could have Dupuytrens in this one place, with no sign of it elsewhere, when my GP thought it was scar tissue. Could it still be scar tissue that has caused my finger to contract? I also am worried, and don't want my hand possibly messed up for months after any surgery.

Please could somebody read and just comment? I am so upset by all this.

Edited 11/14/22 12:10

11/14/2022 14:02
spanishbuddha 

Administrator

11/14/2022 14:02
spanishbuddha 

Administrator

Re: Looking for advice/comments please

Hi Louise

Although we're not doctors can you post a photo? Dupuytrens does often start after some trauma, usually surgery, or wrist fracture or similar, so inflammation form a bee sting might be a possible cause. I too play piano and have a 'restriction' rather than a contracture in one hand caused by scar tissue from an injury and pinkie amputation but this is really old. I can make an octave maybe a ninth but have small hands and amateur intermediate level playing, modern music (Einaudi, Tiersen and similar). A DD contracture is usually caused by a cord which is palpable and if the surgeon says he could feel it you might be able to too. Try stretching the hand finger gently against the contracture and see if either the skin blanches around the obstruction and/or you can feel a cord. If there is a palpable and visible cord NA might be a possibility, and that would be my preferred approach. There are skilled surgeons in the UK who can perform NA, see the BDS list of clinics. One of them would best advise but you need referral from GP. I too, as a piano player would (will) avoid surgery for as long as possible; for some it can be a great success but the risks are too high for me unless or until I have a severe contracture that prevents anything other than basics chopsticks type of music ;) My own plan is to go to Paris for NA when or if the time comes for it to be done.

Best wishes SB

11/14/2022 15:56
Louise1234 
11/14/2022 15:56
Louise1234 
Re: Looking for advice/comments please

spanishbuddha:
Hi Louise

Although we're not doctors can you post a photo? Dupuytrens does often start after some trauma, usually surgery, or wrist fracture or similar, so inflammation form a bee sting might be a possible cause. I too play piano and have a 'restriction' rather than a contracture in one hand caused by scar tissue from an injury and pinkie amputation but this is really old. I can make an octave maybe a ninth but have small hands and amateur intermediate level playing, modern music (Einaudi, Tiersen and similar). A DD contracture is usually caused by a cord which is palpable and if the surgeon says he could feel it you might be able to too. Try stretching the hand finger gently against the contracture and see if either the skin blanches around the obstruction and/or you can feel a cord. If there is a palpable and visible cord NA might be a possibility, and that would be my preferred approach. There are skilled surgeons in the UK who can perform NA, see the BDS list of clinics. One of them would best advise but you need referral from GP. I too, as a piano player would (will) avoid surgery for as long as possible; for some it can be a great success but the risks are too high for me unless or until I have a severe contracture that prevents anything other than basics chopsticks type of music ;) My own plan is to go to Paris for NA when or if the time comes for it to be done.

Best wishes SB
Thank you for your answer. I can't photograph it. I can feel what feels like the side of a lump, which I think must be what the consultant called a cord? If I stretch the skin around it, it looks more like a flat lump than a cord though. I still have good flexibility and mobility in my hands, which are small and thin, except the reduced ability to span notes on the piano because of the bent little finger. If I push down very hard on my finger just below the middle joint, my finger will almost go flat, but as soon as I release the pressure it bounces back up again (this is with the whole palm and underside of the knuckles flat on the table.). I can still raise the finger upwards and downwards from the knuckle joint and the consultant could find no nodules or cords on my palms or other fingers. I'm definitely going to try stretching my little finger to see if that helps.

Edited 11/14/22 16:58

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intermediate   possibility   amputation   straighten   appropriate   inflammation   surgery   orthopaedic   knuckle   contracture   Dupuytrens   investigated   consultant   possible   spanishbuddha   palpable   restriction   obstruction   physiotherapy   stretching