Surprised the research didn't have more to say about the long-term risks of gluing small pieces of marigold gloves to your palms....
In 30/09/05 GP's "Journals Watch" I found interest in this:
(http://www.celebrationhealth.com/handcenter/images/dupuytren1.gif)
Does anyone else have experience of this?
Bonnos, give us the lowdown on this. A lump has appeared on my right hand these last weeks and its in the same place as yours...That link you sited is very good and there's not much info I could add. Reading it I learned some new thing, like people with DC might be well advised to avoid/stop taking Glucosamine and/or Chondroitin and the potential link with Insulin Deficiency - http://www.dupuytrens-a-new-theory.com/pages/1/index.htm
As far as I was aware, there ha never been a good quality study showing a link. I have looked before but never found anything appropriate. I'll have to have a proper look on PubMed when I get the chance.I don't need a scientific study to tell me what I can see clearly for myself. The number of long time climbers coming out of the woodwork with early onset DC is enough to convince me that climbing is the trigger.
All about myofibroblasts.
For my money if/when contracture becomes a problem I will go down the line of Needle Aponeurosis.This is essentially a closed method of Dupuytren's Fasciotomy. Works OK in early stages for contracture release but recurrence of contracture is 100%. But, it's a minimally invasive method. Some say there is a high risk of neurovascular injury (numb finger, worse case amputation) but in experiences hands this shouldn't be too high.
I don't need a scientific study to tell me what I can see clearly for myself. The number of long time climbers coming out of the woodwork with early onset DC is enough to convince me that climbing is the trigger.Fair enough, but this is SCIENCE and not hearsay. It may well be a cause, but very big, high quality studies that showed no increase incidence in recurent palmar trauma. That doesn't mean it doesn't have an input, just that no-one has demonstrated it properly.
For example, fingers involved. Generally it's mostly ring and little, is this different in climbers?
I think this is also the tendon most commonly affected in Dupuytrens.
Strange this should appear on here today as I was at the Jorvik Centre in York at the weekend reading about how it was indicative of Viking ancestry (passed down through the mothers lineage) which is good news as I've always thought I was Welsh.
Are you guys talking about Dupuytren's contracture?Thanks for clearing that up.
It's not really a disease (in terms that most people think of a disease) as it is not contagious. It's basically like a type of RSI.
Thanks for clearing that up.
CONCLUSIONS: This study further strengthens the hypothesis that repetitive trauma to the palmar fascia predisposes to the development of Dupuytren's disease in men.
Mine is about an inch long, halfway between little and ring fingers, and extenidning from "lifeline" on palm downwards. Now got a wierd callous forming on the top end. Doesn't restrict movement at all.Erm thanks, but I don't want to see photos of you one incher thanks.
Maybe we should start a thread "Quality Dupuytren's pics"?
So now thoroughly in the knowledge that i am of viking descent anyone know a good horned hat shop?
Whilst researching this I came across a possible link with Vitamin c supplements, which I coincidentally have been taking the last 6 months. Have since stopped...
Whilst researching this I came across a possible link with Vitamin c supplements, which I coincidentally have been taking the last 6 months.
So many climbers with DC! I just don’t understand why many medical types are so adamant there is no link.
I just don’t understand why many medical types are so adamant there is no link.
A possible 'confounder' might be the higher level of awareness of DC in the climbing community. I recognised mine in the very early stages whereas I've met a few non-climbers since who have far more advanced DC without a clue what it is.
I wasn't really referring to comments made on here, more the reactions by medical practitioners out in the real world.
I'm not sure that's the case, is it? As far as I recall (I may be wrong) noone here has said climbing does not increase the risk of Dupuytren's, only that there's no study proving it.
Here's an out of the box confounder. Maybe people of viking origin are pre-disposed to go rock climbing ;D
Bonjoy,
If my number is on yor phone you can now add me to your lump buddies list. Mine has come on over the last few weeks really.
So jfw was right? You beter wad him.
So jfw was right? You beter wad him.:-\
I've also got a peanut sized lump just beneath my ring finger, been there for about 3 months now. Started with just a pain in the area, then the pain went away and a lump quickly developed there. Specifically, I think training 3 finger drags on the beastmaker was the cause and I'm now avoiding this. Went to see a physio who's also a climber and he said that it shouldn't be anything to worry about unless it starts causing you a lot of pain and it might just go away with a bit of finger stretching and massaging.
Mine are more like lentils.
Went to see a physio who's also a climber and he said that it shouldn't be anything to worry about unless it starts causing you a lot of pain and it might just go away with a bit of finger stretching and massaging.This advice would suggest he doesn't know much about DC. I have never read of it going away with stretching and massage. On the contrary I've read that stretching and massage can have a negative effect as they stimulate inflamation. I'd suggest doing your own research before taking his (or my) advice.
I’ve also cultivated the habit of lying on top of my bad hand when asleep
I'd suggest doing your own research before taking his (or my) advice.
So I went to the Dr and he said it was most likely a ganglion (I see Paul B had this too).
he went on to say if it gets worse - more painful, increases in size etc...then to go back.
Hit it with a book, thats what my gran said, she did it to hers years ago and it never came back apparently :)
If you are somewhat older and develop a nodule then probably you will not develop serious disease and radiotherapy is not worthwhile. Conversely if you are 25 and already have nodules starting I would consider radiotherapy almost mandatory.
anyone getting to the point where something needs doing.
It’s the level of contracture that I’d be watching. The DC tissue/cords without contracture wouldn’t benefit from needle treatment and you actually need some level of contracture in order for the needle procedure to be effective. Can you still put your palm flat down on a table top? If so you have no significant contracture. My little fingers were both at about 45 degrees to the palm at best and ring fingers about 30. They had been pretty bad for a while, probably hadn’t been able to put palms flat on a table top for maybe three years.anyone getting to the point where something needs doing.
Out of interest, what was this point for you? My pinky finger one is about 1" long still, not grown in a couple of years.
I'll be interested to see more extended results for Xiapex.
Dear Dr Bainbridge,
Thank you for the recent consultation. It was good to talk to you regarding my Dupuytrens and I appreciate your recommendations on treatment options.
At the time of the consultation I had was not aware that Xiapex was an available treatment in the UK and had not considered it closely as an option. Subsequent to your recommendations I have had time to look into it more closely.
For reasons I’ve outlined here I would feel more comfortable opting for Needle Aponeurotomy as a 1st stage treatment.
• The risk to nearby tendons appears to me to be greater with Xiapex than with Needle Aponeurotomy. As someone involved in relatively high difficulty rock climbing the stresses I put through finger tendons are well beyond those generated by everyday use and I fear that however comprehensively Xiapex has have been trialled it will not have been used on many people who put such extreme stresses on their finger tendons (i.e. higher standard rock climbers). A ruptured finger tendon would be a devastating blow to me and as such I would rather accept the likelihood of other problems associated with NA (e.g faster recurrence) rather than take this particular risk.
• The possible advantage of Xiapex over NA is an increase in the time between recurrence and hence the need for repeat treatment. I haven’t looked into this exhaustively but have not found any significant claim for this in the manufacturer’s literature. I’m guessing it is too early in its use to carry out a study to assess this. So I am not entirely confident I would gain in this respect. Also this advantage would be offset somewhat by a longer convalescence (I think you mentioned a minimum of a month off climbing per hand), the need for two visits per procedure and more side effects. I think on balance at this stage I would rather risk more frequent treatments with NA rather than less frequent but more disruptive treatments with Xiapex.
• Opting for NA now does not appear to rule out using Xiapex later if the NA does not work out. By the time repeat treatment is required I am hopeful that Xiapex will have been in use for some time in the UK and there will be more comprehensive information about it more widely available.
Can you still put your palm flat down on a table top? If so you have no significant contracture. My little fingers were both at about 45 degrees to the palm at best and ring fingers about 30. They had been pretty bad for a while, probably hadn’t been able to put palms flat on a table top for maybe three years.
.....
Early stage DC (as yours sounds like) would probably benefit from radiotherapy. This might stop the condition in it's tracks before it becomes a problem. Unfortunately this is not available on the NHS and would cost I was told approx £3000.
....Celts might have blame to shoulder though their gene pool could have been muddied by marauding Viking pillagers.
Saw the senior, long served, hand consultant in Cornwall. Not prepared to put the needle into my pinky DD lumps asserting that folk tended to be back in a few months with the relevant finger crooking in. If it ain`broke.......... He had no truck with links to climbing or manual work and suggested that the Celts might have blame to shoulder though their gene pool could have been muddied by marauding Viking pillagers.Same old, same old. As I've said before, it might be a coincidence that the young climbers I come across seem to have a vastly higher incidence of DC expression than the general population, or it might be (if you really want to be a pedant) possible that the gene for DC is linked to a gene which makes people want to become a rock climber, but it seems more likely to me that climbing brings on DC rather than vica versa or that there is no connection. But I see no reason why a hand specialist who doesn't come across lots of climbers, in the absence of any major studies on the subject, would draw the same conclusions and I'm not surprised when they don't.
I suspect there are things which trigger bad episodes but I can never pin down what they are for me
see if i can find a hand specialist north of the border that can advise.
Hi! Can I join the club? I now have a small lump on my left palm beneath the little finger. Slightly tender to touch but not to climb on and no contracture at all (yet?).
Is there anything I can do at this stage to slow further progression?
I did read through most of this thread but half the links were broken and then slackline started waffling on about statistics and proof and I lost the will to live after that. I take sporadic vitamin supplements, not glucosamine tho, and living in Glasgow I get fuck all vitamin D of course...
Hi! Can I join the club? I now have a small lump on my left palm beneath the little finger. Slightly tender to touch but not to climb on and no contracture at all (yet?).Radiotherapy is supposed to be effective at stopping early signs from progressing
Is there anything I can do at this stage to slow further progression?
I did read through most of this thread but half the links were broken and then slackline started waffling on about statistics and proof and I lost the will to live after that. I take sporadic vitamin supplements, not glucosamine tho, and living in Glasgow I get fuck all vitamin D of course...
What are the odds of a big study into a climbing link to DC?
anyway, I know its a slow disease but how slow is slow, will it be 10years before i have to get "the snip" or 50? ect
or does it change from person to person
just reading through the comments i saw SA chris also had a callous form on top of his lump, interesting, i wonder why that happens...
so is massage and stretching everyday (already do this from just doing my climbing rehab excercises) actually meant to stave off the contracture?
Hit the berocca after a cold and it flares up.
Hit the berocca after a cold and it flares up.
No point you doing that.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000980.pub4/abstract
The failure of vitamin C supplementation to reduce the incidence of colds in the general population indicates that routine vitamin C supplementation is not justified, yet vitamin C may be useful for people exposed to brief periods of severe physical exercise. Regular supplementation trials have shown that vitamin C reduces the duration of colds, but this was not replicated in the few therapeutic trials that have been carried out. Nevertheless, given the consistent effect of vitamin C on the duration and severity of colds in the regular supplementation studies, and the low cost and safety, it may be worthwhile for common cold patients to test on an individual basis whether therapeutic vitamin C is beneficial for them. Further therapeutic RCTs are warranted.
I bet all you'll get from a hand specialist (assuming you can get a referral) is 'Hmmm, we'll have to wait and see. Come back if it gets worse.'
Each to their own, but I think your position looks rather kneejerk for someone who believes in evidence based behaviour. On the one hand you have a mixed bag of ‘hand experts’ of varying levels of experience, many/most of whom outside of Sheffield will most usually have come across DC in elderly white men and alchoholics. Read around on the subject and it looks like a large proportion of the ‘experts’ will channel you toward open hand surgery without pointing out or discussing the pros/cons of the (IMO better) needle op. I tend to think this is because they generally deal with elderly sufferers so aren’t used to dealing with people who will have to manage this condition for a fair proportion of their lifespan rather than a decade or two at the end. On the other hand you have a mixed bag of climbers with varying levels of experience of the condition the therapies and how these relate to the hand intensive activity of rock climbing; many of whom are quite bright and have looked into the subject at length and consulted with ‘hand experts’ of all colours. IMO there is definitely value in the wisdom of the crowd in instances like this which relate to a very specific interaction between a physical activity and a disease. Academic knowledge does not always trump firsthand experience. Surely it’s a case of taking every source of info on its own merits anyway. But each to his own.
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. (http://hth.sagepub.com/content/16/2/45.short)
It had good sensitivity and specificity (https://en.wikipedia.org/wiki/Sensitivity_and_specificity) in the small sample size it was assessed in.
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. (http://hth.sagepub.com/content/16/2/45.short)
It had good sensitivity and specificity (https://en.wikipedia.org/wiki/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.
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. (http://hth.sagepub.com/content/16/2/45.short)
It had good sensitivity and specificity (https://en.wikipedia.org/wiki/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'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 (http://www.consort-statement.org/) for diagnostic tool accuracy?
...no randomisation, no control group...
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.
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.
Shit. Just found a small lump for my ring* finger tendon in my RH (its about the size of a large grain of rice). No pain, no contracture. Having schlepped through 4-5 pages of threads - it seems there is little to do about it until it causes pain/problems.. Have I missed anything/is there anything I can/should do about it? Aside from stretching that may or may not help :)
Or is it just wait for it to get bad enough to require surgery? No need to stop climbing/training?
*edit - sorry put index in first post..
I've got 2 lumps on each hand and on my left hand there seems to be growing some sort of worm hole/portal to another dimension similar I think to what Jonboy has. Have only noticed this recenlty and can only say with the little amount of climbing I do these days, it seems to be getting worse the less I climb although it doesn't actually seem to cause any pain, just looks bad?after having 9 months off climbing last year due to shoulder surgery mine has definitely got worse to the point where I might have to do something about it, probably start by taking vitamin D supplements like Tomtom suggested and see how it goes from there although I have just started climbing again although no where near as much as I used to (once a week if I'm lucky!)
My all healing osteopath said that you can massage and stretch them out when they're new...
Yep, i have my doubts too. Climbed for first time since it appeared on Wednesday, and it's already desensitising.
[quoteSA Chris]Why do you think it's not DC?
That sounds like a fair summary. I'd add, avoid high dose vit C and glucosamine supplements, on a precautionary basis as there has been suggestion these can promote DC progression.
I thought I might mention here that training pockets on a fingerboard seems to aggrivate my dups. Not sure if others have a similar experience.
I went through a phase of hammering the shit out of mine with cross frictional massage and stretching, which seemed to aggrivate them. Ignore seems to be the best strategy for me at the mo. I've always been incredibly shit at climbing on pockets, and I only started fingerboarding--including training pockets--about 3 years ago. Mine have all cropped up over this period. Obviously all of these happenings covary with getting old, so I can't really pin causality. That said, since I've stopped training pockets they seem to have regressed.
I went through a phase of hammering the shit out of mine with cross frictional massage and stretching, which seemed to aggrivate them. Ignore seems to be the best strategy for me at the mo. I've always been incredibly shit at climbing on pockets, and I only started fingerboarding--including training pockets--about 3 years ago. Mine have all cropped up over this period. Obviously all of these happenings covary with getting old, so I can't really pin causality. That said, since I've stopped training pockets they seem to have regressed.
Yeah - from the literature they are most commonly (by quite a margin) on ring and little finger - so training the back two is probably not going to er 'help' the situation..
I spoke to Huffy a few weeks ago and he thought that I had this amongst some other issues in my left hand. He said it was in its early phases and asked me to to do some lumbrical stretches kind of like this https://images.app.goo.gl/uifJqDep7LrS4YFc6 but straight armed and palm away from me to fully stretch it. I'll report any observations here.
I hope not literally like that, there's no way any of my fingers will curl that much..
Has anyone experienced this before?
It was a dermofasciectomy with a full thickness skin graft, which is supposed to reduce the incidence of recurrence.
Pinkie was numb for a month, took 2 months to return to regular strength.
I have to wear a splint on it at night to help the tissue lengthen or at least not contract.
It was a dermofasciectomy with a full thickness skin graft, which is supposed to reduce the incidence of recurrence.
Pinkie was numb for a month, took 2 months to return to regular strength.
I have to wear a splint on it at night to help the tissue lengthen or at least not contract.
Out of interest, how bad was it to consider surgery? Mine was nodules for ages (10 years) but has recently worsened. My pinkie is 20 to 30 degrees off straight. It still works and I can climb. Only causes any pain/stiffness if I do squeezey things like using secuteurs (sp?) in the garden.
It maybe coincidental but mine first appeared shortly after taking supplements (glucosamine I think)