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I have Dupuytren's disease -- have had it for a number of years. My rheumatologist retired and the new young guy who has taken over the practice uses terms I'm not familiar with. He mentioned that I have dorsal nodules but said not to worry about it. What are these and should I be worried?

Dupuytren's disease (also known as Dupuytren's contracture) is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. Normally, we are able to control when we bend our fingers and how much. How much we flex our fingers determines how small an object we can hold and how tightly we can hold it. People lose this control as the disorder develops and the palmar fascia contracts, or tightens. This contracture is like extra scar tissue just under the skin. As the disorder progresses, the bending of the finger becomes more and more severe, which limits the motion of the finger. And in some individuals, the nodules appear on the backs of the fingers. These are called dorsal cutaneous nodules. Dorsal just refers to the back of the hand, cutaneous means it affects the skin, and nodules tell us the lesion is a hard knot-like structure. Examining these nodules under a microscope has shown that they have the same structure as the nodules that normally form on the palmar surface of the hand with Dupuytren's. They are made up of dense fibrotic (scar) tissue. Why do they develop on the backside of the hands? That remains a mystery. They may be a reaction to the tightening on the palmar side causing finger flexion and putting increased pressure across the back of the knuckles. They may be extensions of the palmar nodules that develop. Further study is needed to determine the exact cause and if anything specific should be done to treat or remove them.

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