UKC

I've just had surgery to try and correct a Dupuytren's contracture to my left hand little finger and ring finger. Apparently its quite common in climbers?

Has anyone had a similar operation and did you recover to your previous climbing grade (I was comfortable up to about F6b prior to my op)? Also how long did you take to recover? Any tips etc?

Thanks all 👍

I haven't had surgery but I def have this and have seen load of climbers with it...luckily mine has stayed pretty much the same since my thirties...it was only recently in my 40s I showed my mum and she said oh like this and showed me the palm of her hands,lumps in every tendon lol. Cheers mum....I do think climbing really brings it out of you have the gyne....(Apparently come from the vikings ancestry lol)...

I’ve got it, first noticed it about four years ago, but fortunately a) it doesn’t seem to be getting any worse, and b) it’s in my right hand, so doesn’t affect my guitar playing 🙏 

Have a search on here, Pete O’Donovan wrote a good article about it some years back.

Of interest to me as I’ve recently been diagnosed with it.

Yes, had the op about 4 years ago, and it healed very quickly.  Climbing again in about 4 weeks. Seems to have settled down now and the surgery was very simple and quick. Just a local, so you can watch as the surgeon does their work.  Do get it done.

I had it in both little fingers and my palms at different times, it was annoying for putting gloves on (especially when slightly damp) and the fingers continually got caught while jamming.

I had the left one operated on 15 years ago which is doing great, I barely notice that I have had it done. The right one I had operated on four years ago and it is good too, though the scar tissue is still a little stiff and the finger has got a small bend in it. Maybe because I left it longer before having the operation.

I recovered both times reasonable quickly, three ish months, though it took longer to get back up to my grades. I did nothing special recovery wise, just followed my physios advice and started out gently as soon as I could.

When I climb I tape both fingers up to protect them, anecdotally I thought I might have had it come on because of belaying and the rope continually running over those parts of the hand. 

I've had both hands done. My right hand was done in 2017 - I had the Collagenase injection treatment and it worked really well. Back to normal in about three week and fingers still straight as a die, but this treatment has been discontinued because of the cost apparently. My left hand was done in February this year, but using needle fasciotomy. Not nearly as straight as the right, more scar tissue and still quite tender. A friend had the full surgery years ago and says her hand is still tender at times. I think the sooner it gets done, the better. 

I developed it in my right hand (and very mildly in my left), about 4 year ago. Last year i realised I was having difficulty doing press-ups as my right-hand palm wouldn't flatten easily nor without discomfort. 

After some internet sleuthing I got into fascism and videos of cats playing piano (jokes, people) - but also uncovered some useful information about depot medrol injections. 

I went to see my doctor who was open to the idea of using this approach. The benefits of the injections were fast - within a week, and massively improved the condition, giving me back almost full mobility and reducing the lumps in my palm.

A year later and the condition is returning in three new locations around the old site (lumps) so I am thinking of getting further injections. 

In addition, I noticed a slight loss of finger-flexing range back in Spring and now hold 3x2min stretches (bending my fingers back), on 3 days of the week. This was painful at first but has really worked for me in terms of both range of mobility and addressing any discomfort.

The jury is out on r/dupuytrens whether such stretching is harmful or beneficial,  but the same could be said about several of the other interventions including surgery.

I'm on the waiting list, been postponed twice. I guess my inability to hand-jam is not really a priority in the grand scheme of things.  Consultant said NHS can't afford injections now, it all goes to cosmetic surgery!

She thinks it's far more likely hereditary than climbing related. 

That's wild because Depot Medrol has to be cheaper than surgery, surely? I am going to see my doctor before Xmas for a second injection.  I'll report back how it goes and if I'm charged.

Edit - Depot Medrol looks to be quite cheap (https://www.drugs.com/price-guide/depo-medrol). When I saw my doctor I explicitly asked to see a specialist, and with the specialist I explicitly asked for depot medrol. I recall he said something about Sheffield being one of the few areas open to this intervention...so YMMV, I guess.

I discussed this with a hand surgeon recently, his advice was to let it get worse before operating. Likely it would return and subsequent ops are then more tricky. Simple op and quick recovery was the suggestion though. As a consolation prize I got a steroid injection which has worked well on my elbow. Need to ask for the other now!

He was quite dismissive of stretching and massage on the lumps being effective.

Well yes an injection would sound far cheaper than surgery. Sadly I didn't pursue this, I'm not very good in medical situations, I always feel I'm a self-harming liability.

The Dupuytrens subreddit has some excellent detailed testimony around the various interventions and a lot of people have documented their experience, providing links. Results/outcomes seem very subjective and the research is patchy.

I went private and saw a sports specialist a couple of years ago when my first palm nodule appeared. He specialised in hand injuries and it was he who diagnosed Dupuytrens. He applied some vibration therapy. The results were underwhelming if not pointless. That's what sent me down the DYOR path, but I was surprised by the lack of awareness of depot medrol. In the US in particular it seems there is emphasis on surgery - which is only performed if the contracture gets bad. This seems absurdly late!

The stretching I do is a protocol I devised. I will say that it's N=1 but it has helped compared to my previous experience. But, there are some who believe it can aggravate the situation. It's disappointing that there's so little research activity in this area - guess it is a First World problem.

Really ... wow .... Well mine was a General anaesthetic ... I think they've done a 'zig zag'  cut on my palm/fingers ... (cant see it yet as I've got a splint/bandage on until next Friday) ... hoping for a speedy recovery .. guessing 2 months ish  ???

I have it in both hands where I can only straighten the worst fingers to about 40 degrees. I saw a specialist a few weeks ago after a year on the waiting list, and asked about the injection. Unsurprisingly he said it was not very good. I was offered full surgery or needle fasciotomy. I opted for needle fasciotomy. He said it was a 10 minute procedure and couple of weeks recovery tops... I've been putting it off for years as I'd rather have bent fingers that work than straight fingers which don't, so I'm hoping for the best.

The lack of consensus/robust trials in the medical world is frustrating because the specialist I saw had s totally different view and as above, my experience with the injection was a fast and massively improved situation which returned almost full mobility and reduced the lumps in my palm. I understand it is better the earlier you get it.

My guess is it's not a very serious, common or interesting ailment, so a specialist will just do what they know or had previous success with, with little incentive to research or trial better methods. I went to my GP but have been passed on to a private clinic and I get the impression it's a case of dealing with me ASAP rather than any interest in what I want as the outcome.

The injections in 2017 were very successful on my right hand. I went in on a Tuesday morning and the Collostridium was injected into the contracted cords. It was heavily padded and bandaged and I went home with a numb and throbbing hand. Back to the hospital on Wednesday, some local anaesthetic and the surgeon grabs my fingers one by one... and straightens them! No pain, just the sound of twigs being broken. 😖Heavily bandaged again for three days, then a splint was cast to wear overnight to stop 'em curling back in. Manual work and climbing in about three weeks, really good since. All done on the NHS, by the way.

I strongly recommend you raise the issue of depot medrol to whoever you see (I'm not a medical expert, this is not medical advice, I'm likely a genuine idiot etc...). This is the thread that influenced me:

https://www.reddit.com/r/DupuytrenDisease/s/xU5FG7quVr

I’ve had needle aponeurotomy/fasciotomy twice - just over 10 years ago and again quite recently.  It was very quick, almost painless and I was back climbing in a couple of weeks.  If it lasts another 10 years I’ll be happy with that.

But… I’ve been lucky that my adhesions were mostly limited to my finger, not my palm.  Local lesions are more easily resolved, more widespread contractures and noduled might require open surgery.  Ominously, I’ve recently developed some nodes in my palm (maybe from focusing more on open palm strength?)

I think the old collagenase treatments sound barbaric, it’s basically clinically controlled snakebite!

OMFG! I'm glad it worked but damn, that is a visceral description! 🤢😁👍

That's interesting as I feel my Dupuytrens was initiated by use of a Lapis Rollybar - poor programing by me!

I dunno if its helpful, but radiotherapy is also available on the nhs for dupuytrens.

We had a GP come through as a patient with dupuytrens, apparently it is not well known amongst general practitioners that this treatment pathway is available. If you're interested its worth asking about.

I dont know the relative benefits and risks compared to other treatment options, but would be less invasive than surgery presumably. 

I was about to add that the significant alternative to surgery for dupytrens is radiotherapy, had a few do very well with it, particularly given how long and complex the operation is!

I’d not come across anyone getting steroid injections for it, but I see there is an evidence base for it stopping progression to surgery. However, it’s a lot of steroid, and I think the downsides of steroid therapy are often under-appreciated. 

I had surgery (Palmar Fasciectomy) for Dupytren’s Contracture in both hands back in 2008. If anyone wants to read the article I subsequently wrote for UKC, here’s the link:

https://www.ukclimbing.com/articles/features/dupuytrens_contracture_-_a_cli...
 

The surgery was quite invasive and it was a matter of months rather than weeks before I could return to climbing, but once I did, I was very happy with the results.

However, I was warned that there was a very strong chance that the condition would return to a lesser or greater extent and around 15 years after the original ops a new cord in my right hand began making a distinct nuisance of itself.

This time around (early 2023) the surgeon recommended what he called a “Subcutaneous Release” procedure, which is almost certainly the same idea as Needle Fasciotomy, but with a larger implement (he described it as a ‘medical chisel’).

The procedure, carried out under local anaesthetic, was quick and painless, and then it was just a case of wearing a splint at night and waiting for the wound to heal, which was much faster than when I’d had the full Fasciectomy.

That’s the good news. The bad is that just a couple of years down the road, that particular cord has ‘healed’ itself perfectly and is, once again, impacting on finger mobility.

I would prefer not to have the full surgery again, but unless the ‘Depot Medrol’ treatment brought up by Shani has any merit to it, I don’t really think there will be a viable alternative.

Best of luck to you and all the other Dupytren’s afflicted folk!

Pete.