Dear Dr. Roach: I am a 75-year-old retired mail carrier. I have a growth on my palm that continues to grow. It’s not hurting me, but it is annoying and puts pressure on my hand. My hand surgeon called it “palmar fibromatosis” and said to just leave it alone, since it’s no big deal. But I want it gone, and I am at a loss as to what to do next.
J.A.
Palmar fibromatosis, also called Dupuytren’s contracture, is a benign thickening of the connective tissue in the hand. The condition is highly variable. In some people, it goes away, but for most, it progresses slowly over the years. Eventually, people often notice that their fingers will curl and become difficult or impossible to straighten.
Hand surgeons have the most expertise in treatment, and it sounds like yours isn’t too worried about it. (Perhaps it is very early.) We don’t have a lot of options that are proven to slow down progression of the disease. Injection of steroids in the hand may be beneficial for some people with painful nodules. Radiation treatment may be helpful, but surgery is still the mainstay for when symptoms become severe. Injections of an enzyme to dissolve collagen is a newer treatment
Since you aren’t happy with your symptoms, a visit to the hand surgeon to talk about your options would be wise, but if your surgeon thinks treatment isn’t worth it yet, I’d think hard about insisting on proceeding.
Dear Dr. Roach: I’m a generally healthy 68-year-old man with a history of osteoarthritis. I had a successful knee replacement and hip replacement on both hips. After experiencing more frequent symptoms in my shoulders, I had my right one assessed by an orthopedic surgeon who specializes in shoulders.
He took one look at the X-ray and concluded that I needed a replacement. The cartilage is gone as well as a significant portion of the glenoid. He said my shoulder is eroded inward by 14 mm.
I sleep fine, and I have a good range of motion and limited pain. So, I’m hesitant to go through with the procedure. He’s not sure if an anatomical replacement would work or whether a reverse replacement is needed.
I received a second opinion from another highly regarded shoulder specialist, and he pretty much came to the same conclusion. He said I could choose to wait, but additional bone loss would be a real issue. He seemed to be leaning toward a reverse procedure already.
D.S.
I have much less clinical experience with shoulder replacement surgery than I have with hip and knee replacements, but the decision to proceed with any elective joint replacement is based less on the appearance of the shoulder by X-ray or MRI and mrore on the person’s pain and ability to do the things they need to do.
You said you’re having more frequent symptoms, which brought you to the surgeon, but you also said your symptoms now are pretty mild. I suspect that your symptoms will increase, both in terms of pain and function, so it will become clear to you when to go back to the surgeon and discuss the surgery.
As far as the type of replacement (anatomical or reverse), this is well beyond my expertise and firmly in your surgeon’s. I did recently speak to a shoulder replacement surgeon who said there is controversy even among specialists as to when to use which procedure.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
