UKC

Hi,

A month or so ago I noticed a lump in my hand, it was just randomly there, as I was away it has taken me until this week to get checked out at the docs, who confirmed that it was dupuytren's contracture. The NHS being great and all wont do anything about it, as i can lie my hand flat on the table, and feel little pain.

However I am a little worried whether it will affect my climbing? Ive been climbing yesterday for the first time this summer and all seemed fine, just a little discomfort when using my whole hand to smear.

Does any one have experience of this? Or whether climbing can make it worse/better? as the doc didn't have clue. Im really not happy with the prospect of having a claw hand in the future...

Cheers for any help!!

In reply to the ant hill mob:

I've had one in each hand for the last years or so....i've been told to keep an eye on it before anything invasive is considered. It doesn't seem to have any effect on my climbing....I am still rubbish :p

In reply to the ant hill mob:




http://www.ukclimbing.com/articles/page.php?id=1312


Chris

In reply to the ant hill mob:

There was an article on here a while ago (by Pete O'Donvan, I think), about Dupuytren's Contracture that might be worth hunting for.

I'd go with the NHS advice and not mess with it if it's not causing problems - no point having your hand sliced up until you need to (and, to anticipate the argument that it's better to deal with it sooner than later, yes, but as I understand it the nodes may re-grow after surgery so you could be back to square one anyway)

In reply to the ant hill mob:

I would recommend stretching it gently but very regularly, to discourage it from contracting further. I found pulling back the little and ring fingers together, with a straight arm, particularly useful.

In reply to nufkin:



This is much what I was told by a (private) surgeon concerning mine - unless it's very painful or severely curling your fingers in they're reluctant to do anything to it as it may regrow and cause the hand to curl in again, and if they've already done surgery on it repeated operations become more difficult.

In reply to the ant hill mob:

That's a silly and rather snide comment. The NHS *is* great, and will help you - so I suggest you take the advice you've been given. If it's not causing you a functional problem at present, just wait and see.

In reply to Chris Craggs:

Hi,

Thanks for the reply and article, I searched UKC but must have typed it wrong.

I agree that the advice is fine to not do anything as long as the problem does not get worse. The NHS comment roots from earlier experiences as well as this one. And not that I get into silly or snide remarks, but my experience so far of the NHS has been pretty shite!

I was more worried about whether climbing will make it worse, or brings on the 'claw' sooner??

In reply to the ant hill mob:

Realised about four years ago that I had it. Thinking it was best to catch it early I went to the GP, very understanding and immediately referred me to a specialist. The specialist, on the other hand, was very dismissive, not interested in PODs article and even in Sheffield not interested in a link with climbing. Told me that they would only take action if it got worse, which might not happen......

And 4 years on I have to admit he was right - it hasn't got worse, in fact I'm quite sure the nodules (on both hands) are less prominent .

Now on the one hand I have been doing a lot less climbing, but on the other hand I've been doing a lot of mountain biking, which also requires grip and puts impact on the hand. Or maybe I've discovered the cure ! One thing to say is that I've Ergon grips on both bikes.

In reply to the ant hill mob:


I suspect your preconceptions and expectations are your problem. Your suspicion will only harm yourself because, as you have already demonstrated, you do not trust and accept the advice you have been given by your own doctor, instead trying to find the answer from online strangers.
The NHS is one of a tiny minority of health services where doctors can offer you treatments with very little bias from external pressure. It tends to provide for what people need, but isn't great where what people want is different to what they need.

If you don't like the NHS then you can pay to see a sports medicine specialist who will give you the same advice. Lots of intensive climbing may or may not make things worse (there really isn't a definitive answer to your question), it may or may not get worse, and something can be done if it does become worse but surgery now is more likely to harm than help. The limbo of your situation is nothing to do with the NHS.

In reply to the ant hill mob:

For what its worth to actually try to address your specific question, manual work with hands is associated with development of the condition, but nobody has studied climbing specifically, and climbing for a few hours a week is unlikely to be as severe as being a manual worker (also climbing is constant force rather than the shock force of manual work). I don't believe there is any good quality longitudinal evidence however.

Lucas G, Brichet A, Roquelaure Y, Leclerc A, Descatha A. Dupuytren's disease: personal factors and occupational exposure. Am J Ind Med. Jan 2008;51(1):9-15 (PMID 18033693)

In reply to the ant hill mob:

I noticed a lump on the side of my little finger about 5 or 6 years ago with no affect on movement. However about a year or so ago my little finger started to contract from the second joint to a point where it now has about 80 deg contracture. Finally got consultation with specialist after about a years wait and booked in for op to straighten next month. I climb 3 - 4 times a week and also work as an instructor. Not noticed that climbing made it any worse and it does not seem to be contracting further at the moment. Main affect on climbing now is struggling to get hand into crack if jamming. Generally don't use little finger to climb now unless on proper small crimps as otherwise I can't get it on to hold. Just adapted so don't really notice not using it now. Prognosis for op is ok. Although no guarantee to be able to fully straighten and in a small percentage of cases could come back. If you want further info post op pm me.

In reply to the ant hill mob:

took me 5 seconds to find the article
http://www.ukclimbing.com/articles/page.php?id=1312

In reply to the ant hill mob:

My doctor said that it was a common condition among shipyard workers - caused by the hammering of the riveter. When I mentioned this comment to a friend he said that I should complain and ask for a middle-class condition.

In reply to the ant hill mob:


A rather synical opinion given that you admit to not knowing much yourself. The advise you received about not doing anything at this stage was actually correct!!

Surgery is never considered until atleast the contracture is pulling your finger into flexion with your wrist in neutral. Some people have rapid development, other people never need surgery. There's no evidence to indicate regular stretching will help either so I would just forget about it for now until it worsens significantly. I've got Dupuytren's in both hands. Just the ring fingers. Might be climbing related, might not be. There's been case studies linking climbing with Dupuytren's but there are a lot of other causes also linked (genetics for example). My right hand's been affected since 2005, left hand since this year. Hasn't afected my affected my climbing at all. I can't hold a press-up position because full wrist extension creates pain at the nodules. I had some mild pain at the nodules in the first week after development, then nothing.

In reply to splat2million:


Hmmm..

I assume that you have no direct knowledge of the OP's experience with the NHS, which may well have been "shite". Unless you're saying that the NHS are 100% infallible? Perhaps your suspicions are the product of your own preconceptions, and equally suspect?

In reply to Rob Parsons:


As in my reply to splat2million above - maybe the OP's comment reflects his actual experience; maybe the NHS weren't so great in his case. Doesn't seem such an unlikely scenario to me, anyway, FWIW.

I've got DC on my left hand, a work injury brought it on and it got worse so that I couldn't straighten my little finger past 50 degrees or so.
I had surgery, which took a while to recover from and I had to wear a splint for three months and massage it with oil, which was a pain in the arse. Now five years on it's back to about 70 degrees, so it's better but not massively different, despite doing all the stretching and the like.

It's not affected my climbing, other than the scar tissue being painful when jamming. My guitar playing has waned significantly however.

In reply to Mr. Lee:

There's no evidence to indicate regular stretching will help either so I would just forget about it

I have managed this problem (on the little finger side of both hands) with gentle but persistent stretching over many years. I now have full mobility in both hands, and can comfortably hold a push up position. I am confident that my condition would have worsened had I not countered the contractile tendencies with regular extension. My confidence is based on four things: a) it seemed like a logical thing to try b) it seems to have worked c) the condition started to worsen on the few occasions I left off the stretching for a few weeks d) I have seen it recommended by a significant number of health professionals.

It doesn't particularly bother me that I haven't seen "evidence" for this in the BMJ (although I would read such an article with interest).

In reply to Chris Craggs:

As an update to this article, Xiaflex ( Or Xiapex as it's known here ) was approved for use in Europe in 2011.

http://en.wikipedia.org/wiki/Collagenase_clostridium_histolyticum

A few google links seem to suggest it is indeed available on the NHS, but can only be prescribed when there is a 'palpable cord'.

In reply to planetmarshall:
My company has been working on the clinical trials for this drug over the last 10 years. Its not often you get to work on something that can perhaps make a difference to a condition that affects many climbers including myself.

In reply to bpmclimb:

That's interesting. Didn't mean to sound flipant. Most of the things I've read actually advised against stretching in so far as it can actually worsen the development of the contracture. I've always steered clear of actively strectching for this reason but it's good that you feel it has benefited.

In reply to bpmclimb:


Hmmm..

Yeah you are probably right, I am being too harsh about a situation I don't know the details of. My apologies for offence caused to the OP (or anyone else).
Nevertheless, I do think that being suspicious of the NHS as a whole is unhelpful and unfounded because where it does fail it is due to specific problems with specific services in specific places.

In reply to planetmarshall:

Yes it's mentioned here:

http://www.nhs.uk/Conditions/Dupuytrens-contracture/Pages/Surgery.aspx

But it doesn't look as though it has been approved by NICE, which is slightly confusing:

https://www.nice.org.uk/guidance/indevelopment/GID-TAG364

Maybe I'm missing something....

In reply to splat2million:

Well, it's true that NHS don't always get it right, but admittedly it's also true that it's easy to have a moan at them, sometimes. Perhaps the real situation is somewhere in the middle

In reply to Mr. Lee:

Most of the things I've read actually advised against stretching in so far as it can actually worsen the development of the contracture.

I can imagine that being the advice given, as injudicious stretching can cause a counterproductive degree of tissue damage, which then may "heal short". Admittedly, I have done a lot of yoga and other forms of stretching over the years, and (having overdone it a few times in the past) have become very used to gauging the optimum intensity of stretch. With the hands, I'm especially careful not to stretch to the point of pain.

In reply to the ant hill mob:

Maybe have a look through this lot
http://www.ukclimbing.com/forums/info/search.php?forum=0&dates=1&na...
including this from me
http://www.ukclimbing.com/forums/t.php?t=569623

In reply to Liam M:


I think this is exactly right. My sister is a hand therapist and looks at my dupuytren's often. It isn't very bad, and her advice has always just to leave it at the moment and only take action if it gets worse.

It hardly affects my climbing. I sometimes find guppy moves or yarding around on indoor jugs painful, but for 99% of my climbing it makes no difference.

In reply to splat2million:

I have mild DC in the left hand. It came on rather suddenly about ten years ago, but hasn't really got any worse since.

I seem to remember that there was a paper that studied DC in rock climbers.

In reply to the ant hill mob:

I had an operation just over 2 weeks ago for a DC in my right hand. I'm 27.

It started about 4 years ago, initially just small and fairly painless, it got worse for about 6 months then stayed fairly stable for about 3 years. Carried on life as normal, climbing, mountain biking etc, not much seemed to make any difference to it. Then started getting worse.

It was operated on by the NHS. My finger was probably between 5 and 10 degrees by the time of the operation.Stitches came out on Friday. The cut is painful, I have bruising all over my hand and almost halfway down my forearm.

If you want to know anything else just let me know.

In reply to Liam M:


Needle aponeurotomy is minimally invasive and in my experience well worth a go, depending on where the main contractures are. Mine were in the finger and close to its base and the whole procedure took about 10 minutes. My finger is now completely straight and functional. I can still feel that there are some limitations in odd movements but I think I had unusual flexibility before the contractures originally developed.

I had about a 45 degree flex in my little finger for about two years, I guess. My main concern was that I was damaging my knuckle climbing and that I would end up with scarring or maybe a serious infection in the joint (as well as struggling with the thin finger jamming I used to enjoy).

Since the procedure I have noticed some pain in the PIP joint, which I think is as result of the previous immobility. This makes me wonder about the long-term joint damage that may result from the lack of full range of movement. It seems obvious to me that the longer the condition persists the more likely it is that the joints will be damaged and maybe this should be factored in to the advice to do nothing until the contracture is severe. Before I found the right person to treat me I had some pretty ropey advice from non-specialists (including hand surgeons) along the lines of waiting until it was really bad. They also said that I would probably only get back about 70% of my flexibility, which didn't make waiting for it to be even worse seem very sensible!

A lot depends on where the fibrosis is (and the confidence and skill of the surgeon). I was warned that the incidence of recurrence is high, but then there isn't really any reason why NA can't be repeated as required. So far, there's no sign of the contracture redeveloping. However, if the fibrosis is widepread or deep in the fascia of the palm, then more complicated open surgery may be required and then the argument may change.

I don't have any experience of the collagenase treatment but I was advised that it was more painful and carried a greater risk of collateral damage but, again, a lot depends on how widespread the issue is and the anatomy involved. It was described as the second line treatment where NA isn't suitable (with open surgery the third line).

In reply to Mark D:



Have the NHS changed their stance on DC operations?
I was told that they would not operate until the contracture of my finger was at least 45 degrees

In reply to Up High:

Where did you get that information from? I can't say whether they have or haven't changed. I can only say that mine wasn't contracted to 45 degrees.

In reply to Mr. Lee:

I have similar experience to bpm. I've had a DC nudule for about 8 years. I stretch regularly - firmly but not aggressively - pretty much every day, I would say. Some times I get a sharp pain from the nodule, or sometimes from the wrist, but if I stetch through it, the pain goes away very quickly. I have had no contracture and the fingers on my affected hand are just as flexible as on the other hand.

Of course, not having a control, I don't know for sure whether the stretching has helped or not - personally, I think it has. Maybe I'll have a search and see if there has been any research on stretching and Dupuytren's.

In reply to the ant hill mob:

After this treatment the DC hasn't returned according to the patiemt's wife.
for several years. I had in the palms of my hands & the fingers. At first the surgeons would simply cut it out, but it always came back.
I had awful zig zag scars all over my hands. I was told by a couple of doctors that they must amputate the worst fingers, but I refused.
Then I was sent to see Professor McGrouther (pronounced McGrooter)who is an expert on Dupuytrens.He took a new approach. Pins were inserted (drilled) into the backs of the fingers each side of the middle knuckle. This was totally painless, no painkillers. The pins stuck up about 1.5cm above the fingers & on each finger a rubber band was looped around the pins which slowly pulled the fingers straight over about a month & disabled the Dupuytrens
Then he turned the hand palm up & removed the patch of skin which covered the infected area & grafted a piece of skin from the upper arm onto the finger. The actual Dupuytrens had already all but gone. Since then, 5 years ago, I have been totally free of the syndrome. Anyone who has been told that they will lose the fingers, don't believe it. Professor McGrouther now works in Manchester & can be found on Google.

In reply to the ant hill mob:

I'm currently recovering from an A2 pulley injury in a finger mildly affected by dupuytren's. I've lost a little range but have still got extension range in the MCP joint. It's made me consider whether pulley injuries are more likely with dupuytren's, given any trightness at the MCP joint whilst the other finger joints are flexed would presumably place greater strain on the pulleys? Also, I've read that finger and forearm flexor stretches are good a preventive measure for pulley injuries so presumably tightness due to dupuytren's would have a detrimental affect?

In reply to the ant hill mob:

I had severe dupuytrens. My hands are now almost normal and would be but I was a bit lazy on the physiotherapy on one hand.
There are two points I would like to make.
1) It has nothing to do with stress or injury it is basically genetic.
2) It can be fixed, it is no big deal.
Some of the posts on dupuytrens threads on UKC are paranoid. Get over it, you aren't going to be crippled or die.