[Bonjoy]

To be fair I know Haydn and he knows about my experience with DC and Adam may have know this too, but you weren't to know that.

[Fiend]

I went to see a hand specialist, and I got 'Hmmm, we'll have to wait and see. Come back if it gets worse.'

HTH.

[tregiffian]

Had my pinkie operated on yesterday. Being under general anaesthetic no chance to chat about climbing or glucosamine.
I`ll try to quiz the guy later.

[Oldmanmatt]

I've never consulted a live human on the subject and (frankly) self diagnosed based on  cursory research.
Interestingly, until today, I would have said I had no restriction of movement.

But I've just tried the palms on the desk and raise individual finger test, as mentioned above.
Whilst this is easy for most fingers, I can hardly move either ring finger (the only ones with obvious nodules).
So I amend my "no real issues" statement above and guess I will have to monitor it more closely.

I never would have considered consulting a Quack on the subject. Odd lumps are worrying, but not when they are symmetrical/mirrored on both hands (as that makes the really worrying "odd lump" extremely unlikely).


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[tregiffian]

The physiotherapist made a firm connection with climbing - also roadmending,lumberjacking and...... Not pole dancing.

[slackline]

For those self-diagnosing getting hold of a copy of this might be worthwhile...

Pervulesko, Nora, Volker Schöffl, and Christian Gormasz. "Evaluation of a self-diagnostic tool for Dupuytren's disease in rock climbers." Hand Therapy 16, no. 2 (2011): 45-48.

It had good sensitivity and specificity in the small sample size it was assessed in.

[tim palmer]

For those self-diagnosing getting hold of a copy of this might be worthwhile...

Pervulesko, Nora, Volker Schöffl, and Christian Gormasz. "Evaluation of a self-diagnostic tool for Dupuytren's disease in rock climbers." Hand Therapy 16, no. 2 (2011): 45-48.

It had good sensitivity and specificity in the small sample size it was assessed in.

This study is so methodologically poor it is totally meaningless, no useful description of recruitment, tiny numbers, no randomisation, no control group, no point in reading it.

[SA Chris]

So what do other people's lumps look like? This is mine, right hand only, been this size for years

[slackline]

For those self-diagnosing getting hold of a copy of this might be worthwhile...

Pervulesko, Nora, Volker Schöffl, and Christian Gormasz. "Evaluation of a self-diagnostic tool for Dupuytren's disease in rock climbers." Hand Therapy 16, no. 2 (2011): 45-48.

It had good sensitivity and specificity in the small sample size it was assessed in.

This study is so methodologically poor it is totally meaningless, no useful description of recruitment, tiny numbers, no randomisation, no control group, no point in reading it.

Maybe if you read the abstract....

Its not meant to be randomised since there is no therapeautic intervention and therefore no need for a control group either.  Rather its a diagnostic tool that has been developed and is being tested and is asking the question "Can this questionnaire correctly diagnose Dupuytren's Contracture".  Participants will have used the diagnostic tool which consists of four questions with pictures to self-diagnose.  This diagnosis was then clinically confirmed by trained medical experts.  The result shows that the diagnostic tool gives pretty much the same answer in the vast majority of cases as the clinical diagnosis.  Thus it would be useful to make it available for those who are concerned to self-assess with some accuracy before then going and seeing medics.  This reduces the burden on health care by reducing the number of false-positives that are seen by medical professionals.

You're right there are only small numbers, but I acknowledged that in my post, as do the authors in stating their numbers so that readers can assess the validity of any claims.  I've not been able to access the full text so can't critique their strategy of recruitment.  I would hope that in the full text they report the Positive Predictive Value and the Negative Predictive Value too.

[petejh]

RH. 2 or 3 large lumps on pinky tendon, 1 on index tendon. Also similar layout to a lesser extent on LH.

[SA Chris]

How old are you Pete? If you don't mind me asking? I'll be 46 shortly.

[tim palmer]

For those self-diagnosing getting hold of a copy of this might be worthwhile...

Pervulesko, Nora, Volker Schöffl, and Christian Gormasz. "Evaluation of a self-diagnostic tool for Dupuytren's disease in rock climbers." Hand Therapy 16, no. 2 (2011): 45-48.

It had good sensitivity and specificity in the small sample size it was assessed in.

This study is so methodologically poor it is totally meaningless, no useful description of recruitment, tiny numbers, no randomisation, no control group, no point in reading it.

Maybe if you read the abstract....

Its not meant to be randomised since there is no therapeautic intervention and therefore no need for a control group either.  Rather its a diagnostic tool that has been developed and is being tested and is asking the question "Can this questionnaire correctly diagnose Dupuytren's Contracture".  Participants will have used the diagnostic tool which consists of four questions with pictures to self-diagnose.  This diagnosis was then clinically confirmed by trained medical experts.  The result shows that the diagnostic tool gives pretty much the same answer in the vast majority of cases as the clinical diagnosis.  Thus it would be useful to make it available for those who are concerned to self-assess with some accuracy before then going and seeing medics.  This reduces the burden on health care by reducing the number of false-positives that are seen by medical professionals.

You're right there are only small numbers, but I acknowledged that in my post, as do the authors in stating their numbers so that readers can assess the validity of any claims.  I've not been able to access the full text so can't critique their strategy of recruitment.  I would hope that in the full text they report the Positive Predictive Value and the Negative Predictive Value too.

I have read the entire article and it is turd.

Diagnostic tools can and should be assessed by the similar criteria to those of an interventional trial i.e. construct it in such away as make a meaningful comparison with what is done currently and they have not, they could easily have had a second arm of "do you have dupuytren's?"  and it would have been mildly less useless.  Because it could be the case that all the people who were "false positives" according to their criteria would not say they had DC so in fact their questionnaire is no more useful than a yes-no question.   

It may be that this questionnaire is great but because of the way they have designed and written their study they have done nothing more than waste a physiotherapist or surgeon's time.

I am amazed this got by a reviewer.

[slackline]

I've never been involved in the design of a diagnostic tool who's accuracy is being assessed that has a control arm.  The new methods are, in my experience, ubiquitously assessed against the pre-existing "gold standard" for diagnosis.

I'd be very grateful if you could point me to methodological papers on such study designs as you are suggesting or papers where this has been done because as I say I've never come across it before and it would be useful for my work to be aware of such methodologies.  Is there for example an equivalent to the CONSORT Statement for diagnostic tool accuracy?

[tim palmer]

I've never been involved in the design of a diagnostic tool who's accuracy is being assessed that has a control arm.  The new methods are, in my experience, ubiquitously assessed against the pre-existing "gold standard" for diagnosis.

I'd be very grateful if you could point me to methodological papers on such study designs as you are suggesting or papers where this has been done because as I say I've never come across it before and it would be useful for my work to be aware of such methodologies.  Is there for example an equivalent to the CONSORT Statement for diagnostic tool accuracy?

Every modern textbook on research methodology will tell you this!

DON'T YOU SEE THE "GOLD STANDARD" IS THE CONTROL ARM!

You have to compare what you are testing to something else, otherwise it doesn't mean anything.

Go on to Pubmed or even google "diagnostic test study design" and every single article will say you need a comparison group which this study doesn't. 

Or as an alternative here is a really good book which explains how to understand and evaluate study:

http://www.amazon.co.uk/Understanding-Clinical-Papers-David-Bowers/dp/0470091304

[tim palmer]

here is the analogous material to the consort guidelines for anyone who is interested:

http://www.stard-statement.org

[slackline]

You've confused me with your definitions or use of terms as I understand them, as you started off saying that there was no control group...

...no randomisation, no control group...

... now you are saying there is...

DON'T YOU SEE THE "GOLD STANDARD" IS THE CONTROL ARM!

...and the "Gold Standard" is the current existing best diagnostic tool, which in this case is the clinical diagnosis.

You have to compare what you are testing to something else, otherwise it doesn't mean anything.

The questionnaire is being compared to the "control"/"gold standard" so I'm confused as to what you think the problem is with this study design.

They have used a cohort design where you take a group of people who are suspected of having the disease and then assess them using both the new tool and the pre-existing "gold standard" by which they will have been assessed at some point anyway.  This in contrast to a case-control design where an affected group already known to have the condition are recruited and compared using both tools to a second control group who are already known not to have the condition*.

I've a number of medical research textbooks on the shelf behind me (Altman's, Armitage's. Woodward's and Kirkwood's) thanks.  I'm a medical statistician at a clinical trials unit and involved in the design, conduct and analysis of such trials, one thats in early stages is whether we can better predict pulmonary embolisms in pregnant women, where by the nature of the condition you can't utilise a case-control study design and we therefore have to take the cohort approach.


* For others who might be interested in this some reading on these study designs can be found here.

[tim palmer]

I think we are probably best to continue this discussion by e-mail because i think we have a central disagreement about the function of this questionnaire and what an appropriate gold standard or comparator are.

Also I should apologise for not making my point clear.

[Oldmanmatt]

No! Carry on.
It's riveting, I like a good academic battle.


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[tregiffian]

All I know is that my pinkie lumps on palm and on the first bit of the finger were bigger than above. Now , for the first time in years, I can get my hand  flat and when Amy at the surgery takes the dressings off on Monday I shall have to hold myself back for a week or two then.....

[Bonjoy]

Good to see someone is doing a study on DC linkage to climbing. Worth contributing to I think. Doesn't take long to fill in.

https://www.thebmc.co.uk/dupuytrens-contracture-research-survey

[Nibile]

Done.

[Oldmanmatt]

Done, 10 min, must be worth it just to establish a correlation?


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[SA Chris]

Done

[filz]

Done.

[JonB]

I've had what I believe to be a contracture in my LH for about 7-8 years now and since the initial pain and settling down period it has been fairly stable and without issue.

However, I'm now developing the same in my RH and it hasn't yet settled and is causing quite a lot of pain and general weakness in the back half of my hand (shaking hands for instance is very painful). I'm also finding that it seems to be affecting the joint nearest my hand on my ring finger which feels constantly under tension.

My LH issues were worst after my Euro climbing trip, pocketed venues seemed to really aggravate things and my RH issues first appeared after a stint of pocket climbing.

I try not to massage or stretch the nodules as that seemed to slow the stabilisation in my LH (he says with no benchmark), I'm assuming climbing regularly provides enough breakdown/stretching.

I've got a very small lump below the base of my ring finger on the left hand, and got quite a bit of pain in the palm and around the base of the middle two fingers from pulling on a pocket the other night. Didn't feel like a flexor strain (had that before so know what it feels like), this was just kind of an over stretched feeling, I guess. Went and climbed some other stuff and it didn't really bother me for the rest of the night.

Anyone else find pocket pulling an aggravating factor?