UKC

In reply to Jack Geldard - Editor - UKC: Having Dupuytren's myself this will make interesting reading.

Cheers

In reply to Jack Geldard - Editor - UKC: these are something that my father began to get in his mid 50's and have been developing slowly. He's not yet taken the surgical option. However, they're not as bad as Pete's were by the looks of it. He's not been involved in climbing - but i believe his father had it too. So at some point i expect i'll have to deal with the same later in life.

i also know another chap who has this - again not climbing related but possibly to a lifetime of trumpet playing (now trombone due to lack of movement). It might be the case that climbing aggrivates the condition but perhaps there has to be a predisposition in the family to bring it out anyway.

In reply to Jack Geldard - Editor - UKC:
I'm intrigued. I'm 24, have been climbing regularly for about 4 years and have dupeytren's. I was always doomed though, climbing or not, because my dad has it and my mum's dad had it. However, I'm convinced that my climbing has caused it's early onset.
It's been about two years since I first noticed it and it hasn't caused any problems yet.

In reply to Jack Geldard - Editor - UKC:

I climbed regularly throughout my teens to mid twenties when I drifted away from the sport. Climbed to about E1/E2 at the time. I rediscovered climbing this year and have been out regularly both outdoors and Manchester and Stockport Walls.

I was underwent an operation for Dupuytren's Contraction on my little finger 2 years ago when aged 51. As I had not climbed for some 25 years I think it unlikely that climbing was the cause in my case. My father (a definite non climber) also has the condition so genetics seems to be the cause in my case.

More alarmingly the condition reappeared within 12 months and the finger now has a noticeable bend. Not much of a problem when climbing at present but it can give me problems hand/finger jamming. At some time in the future I wll have to have a further operation

In reply to Jack Geldard - Editor - UKC: This is really relevant to our family at the moment. My Mum has just had her second operation on the same hand - the first was 3.5 years ago and it had developed so seriously since that it has reached the point where it would become too severe to operate soon. She was (rather insensitively I thought) told by the consultant beforehand that if the skin graft doesn't take she may well need to have her fourth finger amputated as the 'claw' inhibits the use of the 'normal' fingers. The operation took three hours and a general anaesthetic second time around. Unfortunately her other hand will need surgery at some point soon-ish but they can't do both together as she does rather need one hand out of plaster.

Anyway, my point was that it's probably genetic in our family as Mum has certainly never climbed (although she was a painter and this may have had an effect??). However, my brother does (properly, as opposed to my bumblings) and I think has begun to develop some symptoms but fortunately none severe as he would find it devastating.

The hand she had operated on was more severe than Pete's photo suggests but I'm sure he would agree that it is extremely debilitating - it is surprising what you cannot do when two fingers are so badly restricted.

In reply to Jack Geldard - Editor - UKC:

Very interesting and informative. I have a mate who had surgery for this last year and will no doubt find this interesting..especially as he's in his 30's and so liable to suffer from it again in later life.

Cheers to Pete and UKc

In reply to control freak:
>>

I absolutely agree.
I had the operation to straighten my left ring finger at age 30, as my finger was bent about 45 degrees above flat by then.
I had jumped off a lorry when I was in my early 20's and snagged my wedding ring on the greedy board and hung there for a moment until I was lifted off (lucky not to loose the finger really), but the Consultant did say that although this may have precipitated the condition I would have eventually had to have surgery as my Dad had it too (and on the same finger)
The only residual sypmtom I have is the finger is slightly weaker in grip than the same finger on my right hand, and not just because I'm right handed. As with all conditions, this thing is much better dealt with earlier than later
Bill

In reply to control freak:


As with so many traits in human biology its not a case of "its genetic" or "its environmental", life is not black and white, but many shades of grey.

I've worked on the genetics of complex diseases and Dupuytren's is a case in "hand" of such a disease. Its not solely genetics nor solely environment, its the result of a complex interaction between multiple genes and multiple environmental factors that results in the onset and subsequent progression of the disease.

In fact I used to have a colleague at University of Manchester who was a plastic surgeon and performed surgery to correct Dupuytren's Contracture amongst other jopbs, and was keen to investigate the genetic components of the disease, unfortunately he never got funding for his work.

This may be what you meant, but its certainly not what you typed. Hopefully the above helps clarify things (although it is itself glossing over a lot of details).

In reply to Bogsy: Has yours re-grown at all since the op?

In reply to slacky: I'm aware things are normally more complex than that TBH I wasn't really meaning to comment on the causes genetic or otherwise, I mentioned it more because this is a climbing forum, the article was presented in the light of climbing and I thought people might find the presence of both climbing and a possible genetic link in our family relevant to their lives...

In reply to Jack Geldard - Editor - UKC:

To expand slightly on the above as people seem keen to add anecdotal evidence as to the genetic architecture of this disease.

The disease does tend to cluster in families and is more common in males suggesting that some factors may be X-linked (male:female 3:1). The sibling recurrent risk (lamda-s which is the probability of you developing the disease given an affected sibling) is 2.9 (95% CI 2.6-3.3) (see http://linkinghub.elsevier.com/retrieve/pii/S0363502305008142 )

One putative locus has been identified on an ~6Mb region of chromsome 16q11.1-q22. But this was identified based on one famliy alone and this had a very strong effect (LOD score of >3 in one pedigree is indicative of a very strong effect). This is only a region of the genome, it hasn't identified any disease gene itself, let alone polymorphisms within the gene that result in susceptibility. There will be many other loci associated with disease, and thats before you start factoring the environment into your model.

See also the entry on Online Mendelian Inherithance in Man at http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=126900

In reply to control freak:

Fair enough, but sloppy writing leads to sloppy thinking and does nothing to help dispel the false impressions that people have of genetics v's environments (which is just a rehash of the old nature v's nurture etc.).

The reporting of human genetics in the media is exceptionally poor and does little to help educate and raise awareness of the public and in fact generally tends to give a false impression of how things work and what "finding a gene for disease X" means (the gene is there in everybody, its just that they've worked out the location of the gene in the genome and identified some polymorphisms within it that are associated with an increase/decrease in risk of certain diseases).

Its just one of many bees I have in my bonnet and I thought I'd expand a little on what you wrote in case anyone went away thinking that they may be in trouble 'cause their great Uncle Simon had a hooked hand.

No offence meant.

In reply to control freak:
Nope, the finger is perfectly normal, in all respects except for the slight weakness, and the scar is only visible if pointed out (hardly noticable at all)

In reply to slacky: No offence taken In fact, my point was more that despite there being no Great-Uncle-Simon-with-a-hook *and* that our lifestyles vary, we still have dupuytren's in our family - possibly suggesting that it is complex... it just came out poorly

(It was sloppy writing but in my defence, I'm close to the end of thesis writing-up and being concise is proving difficult.)

In reply to Jack Geldard - Editor - UKC: An interesting article and some useful resources to look further into. As a 27 year old female with no immediate family history I don't fit any of the stereotypes for developing it! I have it at the base of my ring finger on my right hand, I initially attributed it to RSI and overuse of a laptop and button mouse, and still think that may have been the trigger, but it could be due to any number of other causes including climbing, kayaking or playing musical instuments.
I find I can live with it and climb normally most of the time. Climbing outside I rarely have a problem, but indoors it sometimes bothers me, I guess because of the shape of the holds; big plastic slopey holds press on it etc. I usually fold over a few inches of finger tape then cut a hole in the middle to place over the area then use more finger tape to hold that in place round my hand. This stops the area coming into contact with any holds as it can be quite tender and once I've noticed it I'm super-aware of it. This works to a certain extent but it isn't the best solution as it is quite bulky and you loose grip where the tape is, and the tape doesn't always stay in place, does anyone have any other better ideas or practical solutions?

In reply to slacky:
"finding a gene for disease X" means (the gene is there in everybody, its just that they've worked out the location of the gene in the genome and identified some polymorphisms within it that are associated with an increase/decrease in risk of certain diseases).

Although if we're being extra pedantic today, surely we should mention that disease-associated polymorphisms don't have to occur within a gene and can in fact occur in regulatory elements, leading to altered expression of a gene!

In response to the article, I very much enjoyed reading the article and I wish Pete all the best with his recovery.

In reply to Jack Geldard - Editor - UKC:

OK, I now know what those funny lumps (growing every year) in the palm of my hands are!

Oh dear, time to see the hand consultant again!

Rich.

In reply to Sarah H:

Indeed both upstream, intronic and increasingly at long-range from the initiation of transcription such as TATA boxes. In fact its more likely to be regulation of genes than variation in coding sequence that results in the multitude of phenotypic vairants (and this includes disease susceptibility) seen within species (not just humans).

But then there are the additional complications of epigenetics, CNVs, post-transcriptional modification, imprinting, gene x gene interactions (partciularly troublesome when there is no primary effect from the gene in isolation as the statistical models assume a detectable effect from the primary components of interaction terms), gene x environment interactions. The list goes on (and on).


* I wasn't trying to be pedantic (for once) rather give a more rounded view than anecdotes which, whilst interesting and enlightening in their own right, do little to inform on the bigger picture (which is still being filled in).

In reply to Jack Geldard - Editor - UKC:

Many thanks, Pete, for a very interesting article. I have DC in my left little finger: unusually it affects the two end joints (PIP and DIP) and not the palm or DCP joint. I'm pretty convinced that climbing is the cause, or at least the trigger, for it. The onset and subsequent deteriorations have been preceded by minor traumas from pulling on sharp holds.

My DC is not painful at all. It gives me the occasional problem with jamming, though I am able to rotate the finger inwards to compensate for the lack of extension. Another minor problem is finding winter gloves which will fit: I often have to go a size bigger than I would really like.

A few months ago I partially tore the cords by pulling too hard on an overhang (indoors). Apart from some bruising this wasn't actually painful, and it temporarily gave me some extra range of movement, but it's now reverted to roughly how it was before. I don't recommend trying this as a cure!

In reply to Jack Geldard - Editor - UKC:

Thanks for this article Pete, v informative and affects so many climbers

In reply to jazzyjackson:
Good article Pete and best wishes with the recovery. I am however sceptical about the proposed link between rock climbing and Dupytren's. The paper from the 2005 study quoted is uncontrolled and subject to a number of errors and biases. Their own results do not support their conclusions. The only conclusion that is reasonable from their study is that the area merits further investigation. This paper provides an assertion but not evidence that climbing increases the risk of developing Dupuytrens.

Its only natural to seek causes and make connections but Dupuytrens is a common condition and will therefore affect many climbers. There is currently no good evidence in the medical literature that Dupuytrens occurs at a higher incidence in climbers than the general population. A better designed study than the 2005 one would be necessary to investigate this further and test your hypothesis.

In reply to Jack Geldard - Editor - UKC: Thanks to everyone for all the comments. The connection between climbing and Dupytrens remains contentious (though I'm personally convinced of the link) but what is indisputable is the tremendous cost to the taxpayer of the current NHS strategy of doing nothing until the condition gets so bad that surgery is the only solution. I don't have exact figures, but one anaesthetist I spoke to recently reckoned that each operation costs in the region of 3-5K, and that hundreds, if not thousands, are carried out across the country each week. If just a small part of this money was made available for research into the causes of the condition, as well as alternative/earlier forms of treatment, the eventual savings could be huge.
I'm now fully recovered (thanks) and happily throwing myself around at the Sheffield climbing walls in an effort to test the re-occurrance theory!
Regards,
Pete.

In reply to Pete O'Donovan: Pete, while climbing may be contributary if you are genetically inclined to it, it cant possibly be the sole cause. How come people who have been climbing over 40 years like me, or even longer Joe, have never suffered from it. Or indeed thousands of other climbers who have been climbing longer than you. Was climbing with Nick Colton last week and he has been climbing consistently hard for nearly as long as I've been climbing and there is not trace of it. It cannot be caused soley by climbing.

In reply to Al Evans: I don't think I stated anywhere that 'climbing is the sole cause of Dupytrens', but rather suggested that if one is in any way genetically disposed to the condition, it could well be the catalyst. If, say, 2% of the of 40+ males in the general public show signs of the condition, but 5% of 40+ male climbers do, then that suggests a definite link, while at the same time meaning that only one in every twenty of your mates shows any signs at all. I'm glad to hear that neither you nor Nick have Dupytrens, but I could reel off a long list of names from the same generation of climbers (and younger guys) who do. The thing is, unless the topic comes up in conversation, people don't usually think it's a big enough deal to complain about.
Has it stopped raining down there yet Al?
Pete.

In reply to Al Evans: I don't think Pete ever suggested that climbing was a sole cause. Rather he is suggesting that people with a genetic disposition, who would otherwise either never develop the condition, or only develop it late in life, are getting early onset DC as a result of climbing.
I am also personally convinced of this link. I know of at least 20 climbers, mostly a lot younger than the age at which people tend to develop symptoms, with DC, I know only one non climber with DC and he's in his early sixties. OK I know more climbers than non-climbers, but not twenty times as many!

In reply to Pete O'Donovan: You beat me to it! Hi pete.
Jon

Has it stopped raining down there yet Al?


Gota Fria came and went in four days begining of last week, nothing like as bad as last year, not had a drop since

In reply to Boy: And to Pete, I dont think I said, or meant that climbing was not contributary or that you said it was the sole cause, just trying to clarify things for youngsters that might get scared if they read it wrong.
Al

In reply to Boy: Hi Jon, beat you to what — actually getting Dupytrens or just writing about it? Anyway, how are your Dupes doing? Why not post a picture here — it would show people how the initial stages of the condition look before the cords form. Incidentally, do you give any credence to that link with insulin deficiency that people are talking about? Seems a bit of a red herring to me.
Cheers,
Pete.

In reply to Pete O'Donovan: I just mean't you beat me to challanging what Al said, although I had vaguely considered doing an article like yours. Good article by the way!
I did read one interesting article discussing the common thread between all DC related conditions being insulin resistance and or insulin deficiency. The line of reasoning seemed sound, but the science was all a bit above my head to be honest. Would be interested to hear what people who fully understood the subject thought.

In reply to Pete O'Donovan: If you're interested it's here http://www.dupuytrens-a-new-theory.com/

In reply to Pete O'Donovan:

I would like to see some pictures of other peoples too. I was concerned about mine until I saw yours - mine is minor by comparison - about 1 1/2" long and just below the "lifeline" on my palm.

In reply to Pete O'Donovan: Hi Pete, good article and quite encouraging to see how well you have recovered from your op. I certainley agree that a hand injury can be a catalyst for Dupytrens to start.

I cut my right hand open on, in the centre of the palm, on a sharp pebble at Ramshaw rocks. After it healed, I was left with what I thought was a calous, or scar tissue. Which several months later it became evident was not. It was only then that I discovered I had Dupuytrens after a visit to the Doctors. I am now affected in both hands, which as of yet has not required any surgery.

Incidentally, my father also has it, but only developed it in his forties. As opposed to me, in my late twenty's. It would be great if it did get a little more attention/research. But I guess blokes with bent hands isn't as fashionable as some other ailments.

In reply to Jack Geldard - Editor - UKC: I began showing mild DC in my mid thirties, it progressed slowly and now at 54 it seems to have stabilised since I have stopped cranking on tinys.
The CC took part in a survey about 3 years ago, and the results seemed to show a slightly higher incidence in climbers than the general population.

In reply to Jack Geldard - Editor - UKC: I went to a Consultant about it a couple of weeks ago and he refused to acknowledge any link between its development and climbing. Said it was a co-incidence that it had developed, although from my perspective it has only occurred because I have upped my training over the last 6 months. Of course, he may be right, I do have the right genetic background but it seems an unlikely co-incidence to me.

In reply to Boy:


I read it and to me it seemed like an amateur attempt to link a lot of more or less unrelated observations. In other words its pseudoscience. I am somewhat qualified to understand the subject matter being a PhD cell and molecular biologist with a professional interest in diabetes and early, but developing, DC. And to Pete, very interesting article but I don't buy the climber hypothesis yet.

In reply to Dave: It’s clearly ‘amateur’ in the sense that it’s some guy’s theory rather than funded, peer reviewed research. But other than the form and presentation, could you, as someone with a fuller understanding, expand on some specific reasons why you don’t buy the idea. Does the article contain incorrect information? If not, what are the flaws in the reasoning? Thanks
Out of interest, why don't you believe that climbing causes early onset of DC? Would you if a significant proportion (say 10-15%)of your climbing friends in the age bracket 25-35 had DC, or would you only buy the idea if backed up by a large scale study? That is the situation i find myself in. I imagine this proportion is especially high as I live in Sheff and associate with people who have been climbing very intensively for years. The proportion in the wider climbing public may well be much lower.

In reply to Jack Geldard - Editor - UKC I suffered badly from Dupuytrens
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 Marcus:


I looked into the causes of Dupuytrens as I used to have it. The racial theory is certainly correct as a basic cause at least. I am racially north European & had it badly, but also studies have shown that the further south one goes in Europe, the less cases are seen. An Italian professor whose name I forget, did a survey in Italy. The north of Italy has a high proportion of blonde blue-eyed folk who were part of Austria until the first world war when Italy was given that area. As he went south, so the people became darker & the cases of Dupuytrens diminished accordingly until he reached the south coast where people were darker & Dupuytrens hardly existed.
I tried blaming mine on climbing & frostbite, but the experts wouldn't have it.

In reply to D.Musgrave: Hi Dave, your case sounds particularly severe. Amputation must surely be a last, desperate resort. Also, from my understanding skin grafts are required only when the cords adhere to the outer skin and it proves impossible to remove them without damaging the surface of the palm.
It's interesting to hear that you suffered from reoccurance after surgery; what was the time scale of this? As mentioned in the article, reoccurance is apparently far more likely when the middle finger joint (PIP) is affected, rather than the palm/finger joint (MCP).
The treatment you eventually received sounds novel! I haven't come across it on any of the Dupytrens forums.
Regards,
Pete.

In reply to Pete O'Donovan:

The timescale overall was about 8 or 9 years, before it was fixed. It usually took 2 years for the syndrome to grow back & I had it on 2 to 4 fingers at any one time, above the middle joint.
The skin grafts would have been done because of the reasons you mention above (I assume).
Perhaps you could get more info. about the treatment from medical sites, but I found them difficult to access. Try following Prof. McGrouther's Google trail.
I had fun with the pins in my fingers though, as they had large screw heads, so when I saw one of these self mutilation people who put studs etc all over their faces, I would show them my fingers & tell them that it was the latest thing.
I still have slightly bent fingers because they didn't recover from of all the early surgery. .

In reply to Jack Geldard - Editor - UKC: Very interesting thread. I too have these symptoms after 40+ yrs of climbing in the bank. When I visited my doctor last year he laughingly dismissed it and said it would eventually drag my finger into my palm. He just told me to ignore it for the time being. However it has got worse and spread across the palm, but no sign of it effecting the finger as yet. He called it a Gangly, but I assume its the same thing we are talking about. Do I seek treatment now or follow my doctor's advice?
Ps. I am male, long time climber, and my mother's family are from near Malin Head( prime Viking settlement area).

In reply to Sean Kelly: Hi Sean, sounds like Dupytrens. Although your Doctor's laughing dismissal does not say much for his bed-side manner, I'm afraid his reaction and advice is typical of current practice, i.e. don't bother doing anything until one, or more, fingers have been pulled in more than 30° from the horizontal, then operate.
On a more optimistic note, many people have the nodules and cords, but never go on to develop significant deformity, or at least not until well into old age. So unless you're experiencing discomfort I'd probably follow your doctor's orders for now.
If in the future your fingers do start pulling in to the palm, I would personally consider the NA treatment (discussed in the article) rather than waiting for the 'required' degree of deformity for surgery to be approved. That said, let me just repeat that I am in no way medically qualified, and any form of treatment would first have to be discussed with your GP.
Regards,
Pete.

In reply to Pete O'Donovan: Thanks for that advice Pete
Sean

In reply to Sean Kelly:

Don't wait until it curls your finger over into your palm, because then they will want to amputate it. Just demand that you get the same medical treatment that I had, on the NHS. Just INSIST that they consult Prof. McGrouther or at least someone trained by him. if they haven't heard of him. This can be fixed, they fixed mine & it was bad, so they can fix everyones!

In reply to Jack Geldard - Editor - UKC:
Dupuytrens
Just out of curiosity, could you ask for a friendly vote from everyone who has read this article & has, or think they may have, Dupuytren's syndrome? Ask them to say whether they believe this syndrome is caused by genetics or stress on the hands/fingers.
I am going for the genetic cause because:-
1)That is what many experts now seem to believe. Having had it badly, I spoke to some & looked it up on the internet.
2)Blokes (women seldom get it) who do manual things like climbing labouring, boxing & a lot of other similar activities that stress the hands, will obviously look at the cuts, bruises general injuries on their hands & THEN, notice the Dupuytrens syndrome & assume that it was caused by climbing, frostbite (I tried those reasons)labouring or whatever they were doing.

In reply to D.Musgrave:


I don't think it's really a simple case of either-or. It is perfectly possible that to develop it you need to be genetically predisposed, but the hand trauma acts as a trigger for development.

In reply to Mark Bull:
Very good point.
I've just noticed that when this article first appeared, drinking & smoking were mentioned as contibuting to advance of the syndrome. Most of us contributing to this post have stuck to the injury v. genes discussion.
None of us including myself, have admitted to too much drinking &/or smoking.

In reply to D.Musgrave: I've got the start of a contraction (small node and very slight cord) and had assigned it to a climbing exasperated genetic tedndancy, based on knowing a lot of climbers also have it, but as I had only ever read about it on climbing web sites, that is daft reasoning. I would equally well have ticked the drinking box for a few years in the past, guess is not quite such an owned up to possible cause! Looks like a proper survey is needed, with non-climbers too.

In reply to D.Musgrave:

It's clearly quite a complex issue. This is from one of the sites linked in Pete's article: nothing very conclusive, but interesting reading, especially the suggestion that repetitive micro-damage might be implicated, which could conceivably put climbers at a higher risk than the general population.
http://www.dupuytren-online.info/dupuytrens_contracture_trauma.html

In reply to Sankey:Looks like a proper survey is needed, with non-climbers too.
You're exactly right. but as this is a climbing site getting the views of non climbers may be difficult here. It is really a big internet search.
One interesting story I found was about one of the early Christian monks from Britain, can't remember his name, Cuthbert or whoever, was over in Scandanavia to talk to his fellow Christians & had a servant woman giving him a foot massage. She irritated him in some way so he kicked out & smashed her hand into the wall. She had Dupuytren's, but his kick staightened her fingers out, so it was put down to his Christian healing when it was really his bad temper + good luck. My fingers took a month to straighten with modern methods.

In reply to Mark Bull:
Nice one,
Now the plot thickens

In reply to Jack Geldard - Editor - UKC: Now joining you from sunny Catalunya; we drove down over Monday/Tuesday. Hopefully the climatic conditions down here will help to alleviate yet another ailment — golfer's elbow, no doubt exacerbated by my over-enthusiastic 'get fit quick' efforts over the past few weeks.
Getting back on topic, it seems well accepted that serious one-off hand trauma often later leads to Dupytrens. I don't think it's too big a stretch to suggest that multiple repetitive micro-trauma could result in the same thing; in both cases excess scar tissue (the building blocks of Dupytrens) may be the cause.
As regards excessive alcohol consumption being a contributary factor, not being averse to a nice Cabernet Sauvingnon myself, I asked the opinion of an anaesthetist who'd worked on many Dupytrens operations. His answer was that the only times he'd made any connection was where the patients were known chronic alcoholics.
Oh well, that warm rock won't wait forever — better have some breakfast, a couple of paracetamol, and go and see if the elbow thing is serious, or not.
Pete.

In reply to Jack Geldard - Editor - UKC:

Interesting article - my dupuytren's nodule appeared at 25. Four years later it hasn't progressed yet, thankfully. A hand specialist told me a couple of months ago that there's nothing I can do to slow its development - I'll be keeping a look out for news of this radiotherapy treatment.

Has anyone had a nodule for a long period of time without an eventual contraction?

In reply to Pete O'Donovan:
Thanks for the article... I had wondered what the hard lumps appearing at the base of my little and ring fingers were! Oh well at least it's early stages. Am sure (just by instinct) that mine are due to climbing, whatever anyone else's might be due to. Repeated micro damage makes sense to me.

In reply to Pete O'Donovan:

... interestingly, my sister, having had surgery for her dupuytrens, then fractured her wrist. When the plaster came off her little finger had contracted back to its pre-surgery position. She has had eight operations on all but one finger and one thumb, and still it comes back. She doesn't climb. Neither did my dad, who had it quite badly on both hands, but was not at the time given the option of treatment.

I have written on the forums in the past about my own experience of dupuytrens, but never was so much interest shown as is now to your well-informed article. I was initially put off surgery by the horror stories evident on the dupuytrens website (and my sister's extensive scar-tissue) and nipped off to Paris a few times for NA treatment (although it is usual, I believe, to go private, I was able to use the French National Health service, at the Hopital Lariboisiere (close to the Gare du Nord) the cost of such treatment being typically 33.68 euros (2004). However, as they said, I had left it too late for a good result in the left hand (with the little finger bent past the 90 degree point - impossible to jam, because a nightmare to extract, falling off a lot) and a couple of years later had a good surgery locally (under no illusions however - it will, I'm sure, return. I have also had what Chris Bainbridge calls NA (but it's not like in Paris, and he's not consulted with those French founding-fathers of the procedure) in Derby, which has helped the right hand (although he has his own hand-clinic, Bainbridge is also a part of the team in the Pulvertaft Hand Centre, Derbyshire Royal Infirmary, and can be approached on the NHS through GP referral)

By the way, if anyone wants to see what happens if you leave the dupuytrens to itself watch any recent film with Bill Nighy. He has contractions on 2 fingers of each hand to the extent that they appear to be touching the palm. He uses them for some sort of effect, but one wonders why he doesn't do something about it.

In reply to D.Musgrave:

Is that so? I know two women with varying degrees of it (one me!), both climbers.

In reply to gingerkate:

They are called calluses (sp?).

In reply to Chris F:
I wish! I'd noticed the beginning of the curl too but was busily ignoring it, tra la la, you know how you do. The right hand little finger has got a short cord. Bah! I intend to ignore the 'nothing can be done to slow progression' orthodoxy and use my hypermobility and lots of stretching to see if I can't stop them curling up.

In reply to HB1:

But Dupytrens doesn't always progress to the full contracted fingers.
There are many degrees of affectedness dont you agree?
I have done quite a bit of research into this too and have spoken to some affected peeps of varying ages who concur this. Thoughts?

In reply to HB1: With Dupytrens being so common in your family, the fact that you yourself actualy climb seems irrelevant in this case — you were probably always going to get it.
Correct me if I'm wrong, but from what you said about your sister's condition (and possibly your own as well) your family's Dupytrens particularly affect the PIP (middle finger) joint. As mentioned earlier, where contractions occur within the fingers themselves, rather than at the joint with the palm (my own case), the results of any kind of treatment, be it surgery or NA, are invariably less satisfactory, and re-occurance rates higher.
The price of your French NA sounds ludicrously cheap, even if it was a few years ago. Can you expand a little about how the French method differed from what Chris Bainbridge is doing?
Pete.

Funny you should bring this up. Despite the fact that Dupytrens is very rare in Spain (as it is in most southern European countries) a good number of my Catalan climbing buddies, having been well aware of my own condition, have half-convinced themselves that their calluses are actually the first stages of the disease. It seems that climbers are hypercondriacs wherever they're born!
Seriously though, it should be easy enough to differentiate the one from the other; calluses come and go and generally affect the area right at the finger/palm joint. Dupytrens nodules usually appear slightly lower in the palm, and don't go away.
Pete.

In reply to jazzyjackson:

Hi Jason! We've talked about such things before (as my former UKC self RP1) and I suppose you may be right in what you say. However, its not called Dupuytrens CONTRACTURE for nothing! I was climbing with a mate in his 60s on sunday, and he's got the thickenings on his palm, but no contracture - that's not to say he won't have in the future. Also, of course, there are degrees of affectedness (and I wouldn't wish my poor sister's hands on anyone - she has it on one foot now. Even more of a pain/nuisance, she says)

By the by, if ever you want to meet up for a show of hands, I'm bound to be in Scotland for some climbing next year!

Cheers Richard

In reply to Pete O'Donovan: I'm probably being unfair to Chris Bainbridge, because he is one of so few to offer NA in the UK (and him a surgeon too - in France there is much suspicion and some animosity, I understand, between surgeons and the "association pour l'etude et le traitement non chirurgical de la maladie de Dupuytren") and I believe others at the Pulvertaft now offer the treatment. Perhaps I missed the characteristic snap when the chord is broken. Perhaps the French doctors do it with more aplomb (after all, they do thousands of these treatments, and when I went to Derby CB had done only a few) Perhaps Paris is just more romantic a place to go to than Derby!? Richard

In reply to gingerkate:
>> Oh! gingerkate, Relax, no-one is trying to marginalise women. It's just that usually men get it more than women only because they tend to use their hands more physically.
However,I must admit that saying that,I have been influenced by previous posters to change my original position,(which was that it was only genetic) to agree more with the posters who say that it is an inate genetic condition which can be aggravated by physical stress.
Good thread this, why don't one of you contact Professor McGrouther?








belief,

In reply to D.Musgrave:
Doh! So irritating at times how posts have no tone of voice, mine obviously wasn't at all apparent above. To explain, I'm not concerned here about females being marginalised, I was just thinking that if it's rare in women and the only women I know with it are climbers, it adds strength to the argument that it's sometimes triggered by climbing?

In reply to Jack Geldard - Editor - UKC:

Just got back on UKC, so interested to see this thread. For what it is worth I’m going to throw something else into the bag (didn't see anyone mention it, although I might have missed it!). Two years ago I noticed a small lump on my left palm; and a month later on my right palm. The left one got bigger faster than the right one, but they both seemed to be spreading. I looked on the net to see if it could steer me as to what it was, and as soon as a picture of early DC came up I thought ‘that’s my hand’. So off to the Docs, he confirmed it, and sent me to see a specialist. Before seeing the specialist I did some further reading, and the net threw up one of the links that is in an earlier reply to this thread. I noticed that there was a link to the word Glucosamine, intrigued I read up on it, and it said that there was a link to taking Glucosamine and the onset of DC. I had started taking Glucosamine every day 6 months before I noticed the first lump. I stopped taking Glucosamine straight away. I think that this has had an effect. What I have noticed is that the DC only increased slightly over the following month or so, and that it has now virtually stopped increasing. Now this may be due to other causes, but it may also be due to me stopping taking it. The specialist is still going to operate on my left hand as there is one nodule that is big enough to cause me a bit of discomfort when I climb.

I know a lot of climbers, like me, who realise the benefits of Glucosamine on the joints, and that is why they take it. I’d be interested to know if any of the one’s who have DC, to any extent, are taking Glucosamine; and whether or not they think it is a contributory factor.

In reply to gingerkate:
>> Oh all right then, I accept that. But we are all perhaps losing the original point of this thread, which was, which comes first, the chicken or the egg, the Dupuytrens or the climbing, labouring or other stress to the hand. Also I've noticed that few posters have admitted to too much drinking & smoking,which can advance the syndrome. (Said he on his 4th drink & 2nd cig.)

In reply to ‘EscalatorSteve’:

Thanks for bringing this up, it had slipped my mind. I was aware of a possible link between Dupytrens and taking Glucosamine — it came up in the thread running on UK Bouldering (http://ukbouldering.com/board/index.php/topic,4609.10.html) — but, once again, as yet there's little hard evidence.
Your experience is certainly interesting, and given the apparent popularity of Glucosamine supplements within the older generation of climbers, there must be others in a similar situation who could add weight (or not) to the theory.
Pete

In reply to D.Musgrave and Steve and Pete:

Just to add my details to the mix: have never smoked, rarely drink, but have been taking lots of glucosamine (also chondroitin and msm) for about six years or so!

In reply to gingerkate:

My situation exactly, never smoked, rarely drink, but took Glucosamine.

That's it then, irrefutable and overwhelming proof that Glucosamine is the culprit...

In reply to ‘EscalatorSteve’: As I said on UKB, I too was taking itfor about a yearhave now stopped for about 4 months. My dupuytrens hasn't got noticeably bigger since then, but it's hard to say. Maybe I should get two marks tattoed at the ends so I can monitor growth.

In reply to Chris F:

As I said, 18 Months on and it appears to have not got any worse; only time will tell.

In reply to everyone:

Loads of diseases (from depression to heart disease) have both a nature (genetic predisposition)) and nurture (environmental/trigger event) component.

In my case I have a genetic predisposition towards dupuytrens (my dad was operated for it in his 60s, occurence in same hand/place) - but i strongly suspect that the streses/microtraumas involved in climbing have led to the much earlier onset in me (31 now, onset 26/27ish) and other climbers.

i would also theorise that you could have the genetic predisposition and never trigger it or only see it much later in life.

Re lower incidence in women (i'm a woman) - i suspect that the lower recorded incidence in women may strongly relate to:
- less hand trauma (i.e less manual labour etc) in women
- that women generally having greater finger flexinbility may need less interventions (seen as medical statistics) than men (kind of optimistic as a woman that!)

dupuytrens seems to develop as the result of the healing process (in collagen formation) over reacting/not stopping. this over reaction can be triggered by a major injury, or lots of repetitive stresses. some treatments like radiation therapy/ collagenese injections could inhibit this excessive collagen production (but would also be likely to stop the required repair processes that you would probably like to be going on locally if you are a climber).

glucosamine is reported anecdotally as increasing development of dupuytrens, as are other supplements related to healing processes . if you find that glucosamine/ vitamin C helps with another condition (eg knees/elbows) you need to weigh up the risk/ benefits for your situation.

i haven't seen enough evidence/had first hand (ahem) experience to be strongly convinced by the glucosamine link. i guess if i ever needed glucosamine for a non- hand part of my body i would consider if it could be topically applied as a cream (wearing gloves!).

In reply to Pete O'Donovan:

Very interested to hear the potential link with Glucosamine Sulphate. Taking regular high levels of Glucosamine would certainly coincide with my own Dupuytren's onset.

Intuitively, it is not hard to believe in some form of interaction between the two as Glucosamine is taken for assistance with joint injuries because it is thought that it may help in the formation of cartilaginous tissue. Dupuytren's is essentially the (unwanted) formation of cartilaginous tissue. The suspicion is however that Glucosamine will not be the cause of Dupuytren's but may well speed its onset.

Very good article by the way Pete (and accompanying discussion). Though I was told very early on of a possible link between Dupuytren's and manual labour, so I immediately equated that with climbing. I also know many climbers with Dupuytren's yet no non-climbers (not exactly scientific, but does contribute to the anecdotal evidence).

As a bit of a long shot has anyone associated Glucosamine use with sleep disturbance?

In reply to Hugh Cottam:

No - slept badly before, during and after the period I took it.

In reply to Hugh Cottam:


Thats probably more to do with your recent arrival

As you are aware I've taken it for a number of years for my spacky back (Ankylosing Spondylytis) and wouldn't attribute it to sleep disturbance.

In reply to Rich Kirby:

It's taken you nearly two years to reply! Still it's nice to tie up some loose threads.

In reply to ‘EscalatorSteve’:

I too developed Dupuytren's after taking glucosamine supplements for a few months. I have no family history of Dupuytren's (to my knowledge, certainly not parents) and I've never smoked and, to be honest, I'm a bit of a lightweight drinker. I first developed a node in my palm about 4 years ago. It grew for a while and a cord developed along the tendon towards the wrist. But I quickly stopped the glucosamine and it hasn't grown for several years now and I have no contraction yet. That's not direct evidence that the glucosamine was the cause, but I'm not going to take any supplements again.

I stretch it every day, when I remember - this article and thread are reminding me to keep up the stretching.

In reply to El Greyo:
Like you, I first noticed I had Dupuytrens after taking glucosamine supplements for a few months - also about the same time this article appeared. Stopping taking them, and the node has certainly stopped developing, and may well have diminished. My knees are creaking though !

Obviously this may just be coincidental, and have been doing both massage and stretching on the node (when I remember). Do have family history - my grandad had it bad (and wasn't a climber), but given his family was originally from the NE I'm pretty sure we have the viking blood in there somewhere.

Did go and see a doctor, hoping if it was treated early it might help, but they really weren't interested and said it would have to get much worse before they'd operate. Also was very dismissive of the climbing link, or the other treatments recommended in PODs article.

I also stopped taking glucosamine after early onset of Dupytrens in both hands. I'm not sure how much of a difference the glucosamine made, but after developing Dupytrens very early (in my early 30's), I didn't want do anything that might aggrevate it & there certainly seemed to be some sense in the suggestion that there could be a link between Dupytrens and glucosamine. Thankfully in my case it now seems to have slowed down somewhat.

In reply to markk:

I have a contracture in my little finger and I've taken glucosamine. I haven't taken much, but then the contracture is fairly minor.

However, since a lot of climbers take glucosamine for other joint problems, and I don't doubt that years of climbing hard plus, no doubt, the right genetic background, is linked with contractures, the correlation between glucosamine and contractures might be pure coincidence.

In reply to Hugh Cottam:

Just testing Hugh.....good to see your on the ball

In reply to Pete O'Donovan:

FWIW I've been crimping for 42 years now and have taken Glucosamine for about 14. I Don't smoke and drink not much. No signS at all of DC. Amongst my mates one has DC (along with two new hips!)

Steve

what a great and informative article which has clearly reached out to many fellow sufferers of DC.
i just have one little gripe about it...there is a slightly angry comment on the section about NA stating something along the lines that GPs know nothing about it and pah isn't that rubbish of them. well you know in view of the fact that the esteemed chris bainbridge at the internationally renowned pulvertaft hand centre was one of very few specialists offering the technique at the time of writing back in 2008, is it realistic and fair to expect a GP to know about it??
i'm sure everyone is aware of this anyway but gps care for and manage patients of all ages with all conditions, from diabetes and dementia to life limiting cancers, respiratory diseases, complex mental health illness not to mention social problems and medically unexplained symptoms. (i'm just trying to think of the different cases that have walked through my door - or not - in the past week).
so really all i wanted to say was...give us a break. most of us work hard and do our best. if you have DC you might get lucky and have a gp who might also be a climber or who already has a patient with DC, or you might live near derby and be routinely referred anyway to the hand clinic and mr CB to be seen about your DC. really its the orthopaedic clinic/consultant that should be the person discussing treatment options not the generalist at your local surgery - IMHO.

In reply to JoshB:

And to be fair, I think there's a debate about whether NA is worth doing for the temporary relief it seems to provide. As with many other things, French medical opinion and practice differs from elsewhere.

In reply to Dave Garnett:

Little finger of right hand too, just below "lifeline" after taking GS too. Have stopped taking it and DC has stopped growing for a few years now.

Agree with the second para. Not conclusive evidence.

In reply to Chris F:

Agreed that it's most definitely not conclusive evidence. There are probably quite a large proportion of middle-aged climbers who start taking Glucosamine and there are also a large proportion of middle-aged climbers who develop DC. The chance of DC developing following the use of Glucosamine being merely coincidence is therefore quite high. There is certainly enough anecdotal evidence though to merit further investigation.

Due to the nature of DC and how Glucosamine is thought to aid in forming cartilaginous tissue, a link between the two is by no means implausible.

The interesting cases to hear about would be those of people who have developed DC and have continued to take Glucosamine. Do these people appear to have developed more severe DC than those who stopped?

In reply to Hugh Cottam:

Are you calling me middle aged

In reply to Chris F:

You must be. You still snowboard!

In reply to Hugh Cottam:

As opposed to being an elderly skier, you mean?

In reply to Jack Geldard - Editor - UKC: i have a small duptrens nodule which appeared about 3 years ago (in my right palm on little finger tendon) and was painful at first but now, thankfully appears to be no worse or better over the last few years. Have taken glucosamine on and off for varying periods but i am 100% sure this has made no noticeable difference to the nodule. Since i also took glucosamine for a time prior to starting climbing(been climbing 6 years). I certainly can not correlate any pattern between glucosamine and my dupotrens whatsoever.

Cheers
Tim

In reply to Dave Garnett:

Middle aged snowboarder myself!

In reply to Hugh Cottam:

Ah, but I ski as well.

In reply to Chris F:

I would ski, but holding the poles plays havoc with my Dupuytren’s.

In reply to Hugh Cottam: Only old fogeys use poles. Dude :0)

In reply to JoshB:
>>really its the orthopaedic clinic/consultant that should be the person discussing treatment options not the generalist at your local surgery - IMHO.

>> Don't you have to go first to your GP & if they are unsure they can refer you to a consultant. If you approach a consultant directly, he will assume that you're a private patient. Consultants often only do a percentage of their work for the NHS & so only take NHS patients refered to them by GP's.
If you want the best consultant for this, he is, as has been said above, Prof. McGrouther.

In reply to pyle:
Yes, sorry i was assuming that you (patient with DC) had gone along to local GP and said 'what's this in my hand?' or ' i think i have DC' and then the GP referred you to your local orthopaedic clinic. it would then be the time to discuss types and timings of surgical treatment rather than with your gp

In reply to JoshB:

>> I had medical insurance at the time, so it was all arranged by the firms medical unit