Dupuytren's contracture anatomy
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- čas přidán 8. 09. 2024
- Nodules may form in the palm of the hand at the base of a finger, which may progress to become cords that prevent full extension of the finger. This is Dupuytren's contracture or palmar fibromatosis. What is the anatomy here?
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Excellent explanation. I've got it bad in both hands. My pinkies are doubled up almost completely. I'm a self-employed gardener and when the hand surgeon explained the risks and told me how long it would take to get "manual working strength" back, I decided to just live with it. Also, he said the surgery could cause some nerve damage and impaired circulation. It does seem bizarre that in 2023 so little still seems understood about its root cause.
There are option to surgery. Needle Fasciotomy and Xiaflex.
I just had the surgery and it went wonderful. Movement is coming back after only three weeks post surgery. No nerve damage
@@kevinmahan9521 That’s brill. Do you do a manual job like me?
@@josephmilberg6604 I had the “needle job” a few years ago. My pinkey bent back to where it was before in just a few months unfortunately. I’m a self-employed gardener, so my hands already take a lot of stick.
@@stevelanghorn1407 I’m a metal fabricator so yes I do use my hands all the time. I also raced motocross in my younger years and again in my 40’s and the banging on the bars in my 40’s caused my left hand to get severe. My right hand has been severe since I was 34 I’m 54 now.
Wonderful explanation.
As a sufferer of this disease and member of various forums, on behalf of many, we are so often told it's "relatively painless" , we beg to differ. As you had pointed of the extent of nerves in the hands , it can be associated with many different sensations and pain. Some sporadic, some constant. With all sufferers, what applies to some, doesn't apply to others. What treatment works for some, doesn't for others. Once diagnosed, caution not to intervene and awaken the beast. Surgery will often alert the disease "oh no, more injury! Let's lay down more collegen" and the problems often return. More research on preventing progression is crucial.
If there are any budding medical researchers out there..... please.
It’s NOT a disease! It’s a condition. Surgery leads to scar tissue issues, that leads to crystallization & calcification as the body tries to heal itself, terrain is everything. It’s a cycle.
Surgery works but leaves a scar.
@@mweb1scar be damned, the collegen returning fast is a real effect for some that needs to be considered, but it’s not the same for everyone. I think the needling and injection method might trigger less of a respons. (But I don’t know(yet))
I had Xiaplex-treatment twice. After first treatment they still couldnt break the bands. After the second treatment they could, but within a year my fingers were more bent than before the injections, so I had to undergo a fasciectomy in my hand. 3 years later and now I have to have another fasciectomy in that hand. My other hand, had Needle Aponeurectomy twice.
I agree with you about associated pain. My small finger was bent about 45 degrees and I felt the finger every time I needed to open the hand fully, and it hurt to force it further. My surgeon warned against injections, indicating the recurrence rate was high and subsequent surgery after injection treatment is more challenging. He also indicated that surgery was not an option if the fascia continued to tighten and my finger curled fully to the palm of my hand. I went with surgery. After one week I'm recovering well an finger mobility is looking good.
Fantastic and amazing explanation of the problem, the best I have seen.
I have had surgery today in the UK by our wonderful NHS.
I had a general anaesthesia and nerve block to the hand.
There was a large lump and the base of my ring finger and thick cord running down the wrist. My finger was at 90 degrees to my palm. The contracture was not painful...its progressed very slowly over about 5 years.
Already the finger looks almost straight...but dressing still on until stitches removed in 2 weeks.
Up to now, I've no pain after the surgery.
Hope that went well for you, John...
Best Anatomty illustrations on the Internet no doubt .. Thank you for your effort you put out
I started having nodules two years ago, I knew what it was because my mother suffered from it, and I started stretching right away.
It seems to help. Nothing really better to do anyway.
It also seems more common among rock climbers, so I guess doing calisthenics, as often as I do, doesn't help.
This video is the best explanation I've seen so far. I finally understand the difference between the two pathologies.
Fun fact, Dupuytren was a 19th century French doctor who first described this contracture and a full hospital now bears his name in Limoges.
Same here, I'm a former climber and have this contracture on my right hand. I can still stretch out my palm, but I refuse to climb anymore because I don't know how much it can affect negatively.
It makes me laugh ..the whole dont know what causes it. Mine started after a serious injury to my pinky finger which crushed and needed surgery. Then I got the nodes ..so it seems to be from trauma to the hand. .
@@SpecialgiftsLAyeah mine too ... I m 26yrs old a had a hamate fracture after punching through plywood and hitting the wall (very smart of me 🙃) and now I got diagnosed with this
@@SpecialgiftsLAinjury triggers it, but it’s definitely genetically disposition inherited from family. I had a small knife injury which developed a nodule when I was twenty 25. I always thought it to be scar tissue, but it started to really develop around the age 45. I now also have nodules and strings between both middle fingers too. (And it seems more nodules will come in time..) my mother has it, but only started to develop around 60 and her case is much milder so far.
Hi I’m female just turned 60 regard myself as very active and fit ,after doing manual work most of my life including baking and gardening for the last 25 years all have included using my hands and strength for my job .I don’t smoke ,drink or eat red meat . It started with a nodule in my left hand around 5 years ago just from my little finger and has gradually got worse bringing my little finger forward.I made an appointment with the doctor when it first appeared after researching what it could be and was told that nothing could be done until it got worse. Well now I can’t place my hand flat on the table and it causes pain if I try I’m sure something could have been done before now . I have noticed a nodule has appeared in my right hand I am worried .It seems that a regular heavy usage of hands may contribute to this condition.What to do next ?
Thank you for your excellent video
I'm a doctor and learnt my anatomy 25 years ago, if ever I need a refresher I come straight to you. Your youtube videos are second to none and blow me away with their clarity and detail every time! If only your resources were around back then!!
Recently diagnosed with this. Excellent description. Thank you.
A ha! Thank you for explaining the organics of this annoying disease… and thanks to my Dad for passing this trait along to my brother and myself.
I am a female, and Dupuytren's contracture appeared on me in my mid-thirties. It first showed on my LT hand after an injury and surgery to repair a comminuted fracture to the 5th metacarpal. The hand specialist said my situation was 'unusual' in that I was not a male, not in my mid-50's, not an alcoholic or diabetic, and no one in my family (either side) had the condition (all of the above are considered potential causes or risk factors). He then chuckled and said, "I can tell you are Eastern European".
I acted like I understood what he meant at the time, but I walked out having no idea what he had actually told me. So, I began researching the condition. However, at the time 22 years ago, there wasn't much more information than there is today!
Over 20 years later, it showed up on my RT hand after gardening particularly vigorously with a spade pressing strongly into the palm of my hand. A blister appeared, and at first, I contributed the pain to the irritated site. However, I soon realized the pain was further up into the pad beneath the fingers at the base of the 4th and 5th digits. The condition came on suddenly, painfully, and with nodules forming & swelling. Although the condition in my left hand has remained stable and relatively the same for the last 20 years without progression (and no 'rod'), my right hand is very different.
A firm 'rod' ejection appeared almost instantly from (or towards?) the 5th phalange. I am baffled and depressed at this new manifestation. I am searching again, now, for causes and solutions, and I am VERY surprised only a few other (questionable) treatments have emerged. It is so disappointing - but I am so grateful for you and your in-depth explanation of this and other conditions. Thank you.
I am 24 years old I'm in the same boat, I really hope it doesn't get much worse but since I'm so you the probability of regression is very high. This really is an awful disease.
That's fascinating really excellent description
I’m a classical pianist and a Fingerstyle guitar player. It’s my life. I have this in both hands… I can still pass the table top test but I’m terrified…. I really hope it doesn’t progress…
This is outstanding. Thank you. I’m trying to understand my own situation and not sure what I have but I’m definitely seeing a hand doctor, but this is helpful in preparation for the visit.
What a clear and helpful summary. As a sufferer, I found this very interesting. Thank you.
Thanks for finding great examples to strengthen our anatomical understanding.
I've had my operation less than a week ago (right hand's ring and middle finger, and the surgeon said that the pinky was just starting to be affected).
This is DEFINITELY interesting 😉
I discovered I had this condition about 15 years ago. Had the Xioflex injections twice in 5 years with minimal success. Nobody else in my family has it. There is some Finnish ancestry in my DNA but mostly Eastern European. Right had has nodules only. I’m a woodwinds player with medium sized hands and the bass clarinet is getting tougher to play. Using alternate right hand fingerings but don’t have that option on sax. Be well and hope we continue to learn more about this condition. Thanks for your very informative presentation!!
Thank you, now I understand 🥰 you articulated this beautifully. My father had this and now I do ☹️ I never knew hands were so complex.
Thank you very much for this video!!! My husband just had surgery for this, but it is forming in other places and we were unaware that it was the early stages of the same problem. Now we can start working on preventative measures on the other ones.
A well done and well spoken explanation that a meat head such as myself greatly appreciates. Thank you for sharing this knowledge with us all ❤
great video explaining this problem as I have it in my right hand where little finger and and the one next to it and mildly in left hand and work as a mechanic for 30yrs and I have surgery book later this year yes there are slight risks but they confident it will all go well
76 yr old female here, mine started 2008…. Various fingers both hands, I am now on the NHS list again for my tenth op, been told again it will return, luckily recovery is just a few weeks.
Thank you for a clear and understandable explanation.
Thank you so much for this excellent visual explanation of what's going on with the condition. It's really helpful to not only read what it is but to see that actual components involved. I love know envisioning what is going on inside my hand and it's all very interesting. My orthopedist diagnosed my condition as Duputren's but I don't understand why he thinks it's that and not trigger fingers, as I have three fingers (mid and ring on one hand, and ring on other) that are triggering. If you can explain how each of these diagnoses differ in another video - or if you already have done so - I'd love to learn more about that. Mine is very early in it's development so I don't see nodes nor are my fingers pulling forward at all. I still have great range when extending. My troubles really seem more like trigger finger, and I'm now having a hard time closing my fingers, not at all opening them beyond the triggering. I play piano and use a lot of yard tools and have to imagine this has added to the problem if not caused it if it is just trigger finger, and I don't want to give up either of these although I have for now. Well, I'd love to better understand how Duputren's differs from Trigger Fingers in the diagnosis process. Please share a link if you have a video on that but even if not, I greatly appreciate the excellent video above. It's so much clearer and more detailed than anything I've read. Thank you!
I am the same seem to have both conditions and I have pain at times especially when driving palms leaning on steering wheel
@@lynryden3910 My orthopedist has been very helpful and doing things I thought will help have been too. Soak hands under war/hot water every morning for a few minutes eg kitchen sink is fine. Before going to bed at night, ice them for 10-15 min. I also am very mindful of things I do that require a tight grip eg yard work tools and even playing the piano bother them. Because I also have another issue with my hand - DeQuervanes Tenosynovitis (sp?) - I was given a brace to wear when I'm doing things that require my thumb use a lot. Although this isn't directly related to Dupuytren's I have realized that wearing this to bed can help relieve that pain too. Bottom line: Enabling your hands to not clench at night when sleeping can also be of help. And resting them, warming them, icing them, and not overusing them can go a really long way to making them better. I wish you well, Lyn!
An absolutely brilliant description of DC. I have it in one hand, centred around the base of the forefinger, which I think is slightly more unusual. Not too badly, but it is somewhat annoying. Nonetheless, a fascinating glimpse into the cause(s)...now for the cure... 🤨
I had two separate injections. First with enzyme. It came back within 3 years. The second injection was not with the enzyme (too much$ for insurance). That procedure lasted about 2 yrs. Just now have had the surgery. If it comes back again, I'm going to have them take the finger off...
Great presentation! I saw some examples of, apparently very effective, Chinese methods; whereby you grasp a thin pole with your finger tips and exert some pressure and with a knuckle of the other hand, or a tool, press very hard into the nodule and then slowly along towards the wrist, but not into the carpal tunnel. I told a 78 year old friend this when he showed early signs and was afraid of having a failed surgery, such as his friend did. He tried it and was persistent in this and lo and behold it worked. He did short gentle stretches, never prolonged or to a maximum, as well as this rather forceful deep massage. Another friend of mine also tried, but his was at a stage of the traditional “trigger finger”. However, it too worked and the obvious strong ligament looking (iron bar) rod that bent his finger, had truly lessened and he maintained this and the result was actually impressive. Just thought I’d add this as I’ve seen it work and think I also lessened a little nodule and signs of the rod forming (probably from an old climbing drop once) and mine also went down over the period of a few months to not noticeable now. Thanks for a great video indeed.
Thanks for the tip! Can you post a link to this procedure? I really want to avoid surgery or even the needle treatment.
@@jerrelboyd2441 - There’s no link to anything, as there isn’t one; as I only heard of something similar being tried (without the stretch) through a friend of mine and then adapted it and tried it on a few patients in my clinic and of course myself, so further developing it as we went along. With perseverance and dedication this has worked.
@@dr.s.p.muito obrigada, vou tentar fazer, de acordo com a sua explicação
Thanks for this video.
Excellent description, helping me consolidate my knowledge and improve my treatment and explanations to patients.
Just subscribed to your channel turning it into 800K...Congrats!
An absolute legend. Thank you @samwebster for making me love anatomy again!
Great video, brilliant presentation. I had surgery on my left hand 2 years ago, right hand being done next week with injection procedure.
I’m a female,Polish ancestry. Mine started in rt hand 30+ years ago, now in my mid 60’s, 4th digit is bent 30% having surgery in November.
Thanks.. Very interesting coming from a left hand Dupuytren's patient, early stages
I had surgery on my contracture a few years ago. I recoverd quite quickly. However, within a year it began to return. It is becoming difficult to do certain activities, but I am so reluctant to have surgery again because of the shot they gave to numb my hand. It had to inject into my nerve and It was the most painful thing I have ever experienced in my life.
When the doctor came to give me the shot, he had a nurse at each foot, and one at my shoulder. I am not sure I can go through it again.
I am gong to see a doctor about it, but Im hoping they can just knock me out or something, I just cannot endure that shot again.
This diesease can cactually be extremely painful. Please talk to more people affected by this. You will find this is a debilitating disease causing inflammation and swelling.
There’s no answer you just have to live with it !
Have it my thumb and pinky on my right hand. My thumb has a thick chord running to my palm and hurts holding things. My pinky has a dent in my skin but so far full range of motion and I can bend it back to or past 90 degrees.
Great video, thank you. Very well presented
Great explanation. Great haircut.
Fantastic explanation, thank you!
Doc: "Been slappin' up the pharmacy eh?"
Patient: "Just fix my hand bro."
It most definitely can be hereditary. Both my brother and I have polyfibromatosis syndrome. We both have plantar fibromatosis (Ledderhose’s disease ) Dupuytren's, erosive arthropathy in the shoulders, some skin manifestations, and let's just say if I had been born with a penis, it would be included on the list. But this is the kicker: Both of us had daughters with Ehlers Danlos Syndrome. My brother's daughter has Williams Syndrome that comes with a side helping of EDS, and my daughter had an EDS mutation from hell. There was no genetic testing at the time of my daughter's dx but they thought it was Vascular type. Looking at the new nosology of EDS types now, it was probably Cardiac-Valvular Type. My husband's genetics point to aggressive osteoporosis. My mother in law is end stage with it, her mother had it, and her side of the family all had it. Then my contribution was a fibro prolific connective tissue disease and boom, we lost her to EDS after a painful 12 year decline at age 30. Funny thing is she would be just as fascinated by the genetic patterns here. She was a curious and smart nerd like her parents. At least she got some good with the awful.
BTW my husband's family insisted this was all my side of the family's fault. I had to explained to them that osteoporosis is a connective tissue disease. Oh and i was a nurse 30 yrs and my brother is an internal medicine doc ( both of us just retired).
Very interesting and helpful, thank you!
Thank you!
Nodule
Cord
Base of finger
Thigh structure
Painless
Progressive
Men
Middle age
Hereditary
Northern European
Idiopathic
Skin -> connective tissue -> gripping -> palmar aponeurosis
Palmaris longus muscle
It is hereditary. My Dad and brother both had it. I also have it.
I am awaiting tests for dupytrens as I have a nodule on the palm .
Mine was from an amputated fingertip ( ring finger )that was misdiagnosed as minor , resulting in a long fight for 8 months to get treatment.
My tendons are pulling and I’m unable to straighten my injured finger & little finger
Almost 2 years on and finally getting tests
It is obviously onset by trauma to the hand or fingers. This area is so so delicate and sensitive.
@@SpecialgiftsLA thank you for reply 👍
A test revealed palmer aponeurosis & thickening .
Early dupytrens they said .
I really wish I was not misdiagnosed.
I’ve got a hard lump that’s been there for a few years but my fingers can be placed flat. Nothing is stopping my fingers from opening up. It’s like a hard lump and I feel it when changing gears in my manual car
Best sir in the world
Xiaflex correllated with heartproblems (phizer)
Fabulous. Thank you .
That was very interesting. I only noticed one of these lumps in the palm of my left hand after a few months of regularly holding my phone for an hour or so each day when I became a daily active user creating and uploading images to my Instagram channel. Sometimes my hand would get pins and needles from clutching my phone. I wonder if it was caused by poor circulation, or maybe that's just a coincidence.
I broke my wrist 6 weeks ago. They put my hand/forearm into a fibreglass full cast. I felt that my cast squashed my hand and fingers together. After 7 days, I noticed my hand/ palm was cramping from being stuck in a position in the cast. Then I noticed a very sore nodule develop down from my ring finger. The physiotherapist changed my cast and gave me some squeezing exercises to do, but a cord developed, and it's sore. I just had my cast taken off after 6 weeks and the dr said it was a dupeytrens contrature and it was hereditary... not caused by the position my hand was squashed into my hand/forearm cast.
I just wanted to put it out there for research considerations as I developed it while in the cast, but no one wants to suggest it came from my cast positioning. Maybe cast procedures should be changed????
Thank you for the informative video series. I am just writing to ask if anyone has had any luck with massage or stretching or any other non-surgical interventions that might be able to reduce the amount of collagen building up and/or decrease inflamation in the fingers?
I'm 47 and only been climbing as a regular pass time for the last year or so, but have recently been getting some acute pain in my ring finger from climbing, as well as any work requiring a firm grip (e.g. forking a garden bed). Recently a muscuolo-skeletal specialist diagnosed me with early Depuytrens contracture, but I also hypothesize that my relatively acute pain during climbing may be caused by nodules on my finger tendons (like trigger finger) being pulling through the A2 pulley under pressure (I can feel a small ridge/bump pulling through when I lightly pinch my first knuckle with the other hand and then flex my finger). My main concern is that I may be worsening the condition the more I climb, and I've just had approximately a month break without the pain or finger swelling diminishing...
Tenho essa enfermidade na mão direita há 5 anos e durante 2anos fiz fisioterapia e alongamentos e não houve nenhuma melhora 😢
Eu tenho essa enfermidade na mão direita, e sim sinto dores, gostaria que você falasse um pouco sobre o medicamento Xiaflex, pois moro no Brasil e esse medicamento não está disponível no meu País.. agradecida 🙏🏼
I have this and and surmise that I developed it after an impact injury, gotta find a way to cut it out because it’s interfering with exercise on the rower and bike.
Wear cycling gloves while rowing (and cycling) the nodules are a bit irritating but until your fingers are really turning inwards, it’s quite manageable (for me at least, until now)
Im Vietnamese with no apparent connection to nortbeen europe. My grandma had locked palms. I have it only in my left thumb. Dont think my dad had any.
Interesting!
Is this an autoimmune condition? Research seems to say it might be.
Imam kontrakture obostrano više na levoj ruci.ima više objašnjenja o ovoj bolesti ali na srpskom jeziku nigde nisam pronašla objašnjenje,a tako bi volela da mogu da pročitam o kakvoj bolesti je reč.
Nazalost nema na internetu ne znam zasto ali i ja licno nista nista nasao
Extremely interesting video! I was wondering if you could maybe make a video about cysterna chyli & the thoracic duct? I think lymphatic system is a really cool theme :D
I m 26 years old and after a hamate fracture I got diagnosed with this. At the moment its not affecting me at all its at the early stages. I m not of North European decent but Southern European & Balkan. Any natural remedies to prevent from having my fingers curled ?
At the moment, no preventive remedies seem to exist. I also feel overly stretching doesn’t really help. Don’t overly aggravate. (I have seen a cast holding fingers straight that you could wear during night but I haven’t used it, I doubt it would work) keeping fingers supple, wear gloves when doing hard labour.
My teacher
Since the condition lays down collagen I wonder if I should stop taking collagen supplements? Also I lift weights, I wonder if gripping hard is adding to progression?
many patients seem to think the same so I avoid it as well
My husband has been a contruction worker all his life and he had his first nodule at about age 20 and now he is 68. He just had his first surgery. I would say hand trauma definitely adds to the contractures. I would try and avoid hand trauma if you can. We are waiting to see what his hand can do now after the surgery. It is healing, it has been about 3 days, so he hasn't been able to move his hand much yet. They cut the contractured finger with a needle.
@@gowest5145that's a very good point you make about hand trauma. Unfortunately, in want cases and jobs where a degree of hand trauma is unavoidable can be a tricky one. How's your husband recovering after surgery? I hope he is doing well. All the best 💪💪💪
Until so far, diet doesn’t seem to have an impact. Diabetes might be linked, (unsubstantiated) so don’t get that but otherwise, don’t get your hands injured, wear (cycling) gloves when handling weights.
Professor, My name is Coke from Thailand. Now, I'm using your video for constructing the basis for sport. Do you recommend me for the reason?
I am 24 years old and I already have this, I am really worried bout my future. It is also progressing quite rapidly.
I feel like if you weren't an anatomist you'd happily be a hand surgeon. (Thank God you're an anatomist, I'd fail every exam otherwise)
Is it possibly a fungal infection?
Nice 👌🏻
HI, Sam .I have just discovered your channel , certainly some fascinating videos to look forward to . I am not a medical student , but have always been interested in Human anatomy . would it be possible to have a video on ,the Circle of Willis or ,MS please ? Kind regards and best wishes . Tony .
He does have a video on that! Just search Sam Webster circle of Willis
czcams.com/video/Yn9t5YrVdQc/video.html
@@william_shakespeare Thanks , William
What diet advise for this? Could supplementing with enzymes help? Should you take more collegen or less? Light therapy? Anything to avoid surgery or even the needle or direct enzyme therapy? Thanks
A simple anti-inflammatory, anti-oxidant diet may help.
No diets would help conclusively. There might be a link with diabetes, but that’s unsubstantiated. It’s genetic, as such bad diet is not the root cause. (Not that healthy living would make it worse…)
Hi I'm sixty years and have it in both hands the doctors now just want to operate. ..please help i also suffer from arthritis in my joints.
See about a consultation with Dr Gary Pess. Sometimes you can use a micro-needling approach for improvement unless it is too far advanced.
My husband has a pretty far advanced case of dupuytren's contracture and he just had the mircro needle approach done to one of his hands. He is 68 and has had this his entire life. It definitely straightened up his finger a lot but it still can't extend all the way straight but much better than what it was. This was his first surgery of any kind and he has had this since he was 20. It has just been 3 days so it isn't even healed yet but his grip is much better. He could hardly pick up a cup of soda and now he can pick it up. The surgery was pretty tough, I would recommend that hand being totally numbed for it. They just numbed where the needle went in and he had some pain with the surgery.
good
Not hereditary. Decades of incorrect nutrition. Changing back to natural nutrition seems to be too late and intervention is needed.
Diet doesn’t cause it. Diabetes is rumoured but very much unsubstantiated. The disease is genetic, injury can trigger the onset, otherwise everything else is not proven and conjecture.