Dupuytren's Contracture

[maybelateron]

Dupuytren's Contracture is quite a common problem in people who do work involving repetitive gripping with their hands, and also with vibrating machinery. Perhaps not surprisingly then, arb work is an ideal career to increase your chances of this condition. I had my surgery for it yesterday, and a few people expressed interest in a thread on the condition and its treatment, so here goes. There are some other causes for the condition, one being family history.

 

Dupytren's Contracture (DC I shall abbreviate it to) is a condition usually mainly affecting the hands, but it can affect the feet, and rarely present as Peyronie's disease, affecting the penis, believe it or not. The process is one where the tissue layer between the skin and the deeper layers of muscle and bone becomes thickened with excessive collagen, and this contracts. As a result of the contracting, some of the fingers are then pulled in towards the  palm, like a claw. The most commonly affected fingers are the ring and little ones, but the middle can certainly be affected. I have never seen a  case affecting the index finger. The mechanism in the feet is similar, but much rarer. When it affects the penis, which is not at all common, the flaccid penis looks normal, but when erect it pulls to one side, due a band of tight tissue on one side preventing equal extension of both sides of the organ.

 

I have attached some photos of both of my hands. My left hand, which is the one I have had done yesterday, started over 20years ago, before I was a tree surgeon, and was very minor for many years; it is probably the last five years  or so where it accelerated its progress, more rapidly of late. My right hand is in the earliest stages, but I suspect will develop more quickly.

 

If DC is left to progress too far it can reach a point where surgery cannot reverse it fully. I recently met a lady in her fifties who had just had her little finger amputated due to a very aggressive form of DC. She had had previous surgery, but surgery cannot prevent the condition recurring. If the only joint affected is the metacarpophalangeal joint, the one where the finger joins the hand, the surgery is likely to get a good result. Once the DC has progressed to the next knuckle along the finger the success of surgery can be more limited. If you have ever managed to see Bill Nighie's hands this is a case of severe DC.

 

The pre op pictures of my left hand do look like it is the tendon that is affected, a common misunderstanding, not surprisingly when it look like this. My ring finger is the one most affected. The little finger is totally unaffected, and if it looks slightly flexed this is something I have on both little fingers that is hereditary and not progressive. My middle finger is involved in that a "cord" (the surgeons word) had started to extend from my palm into the base of the finger and was pulling the finger slightly into flexion/bending, but more so that it was pulling the finger sideways towards the ring finger.

 

I am guessing that for a chainsaw operator the risk of DC is greater for the left hand. I say this because the left hand carries more of the weight of the saw when operating it, and also suffers more vibration than the right hand does, either on a rear handle or top handle. And the sheering force (again the surgeons words) of pulling on ropes and you have an ideal set of risk factors for DC, I reckon.

 

In terms of symptoms I have never experienced pain with it. The problems as it progressed for me were difficulty getting me hand in and out of pockets and into tight spaces, typically when spannering etc. A more domestic problem was when getting breakables out of the kitchen cupboards I have had to be careful to make sure I didn't unwittingly pull out something I was not holding. When glasses or crockery drop onto a solid floor there is only one outcome! Another frustration I had was that my ring finger would brush the escape button at the top left of my laptop keyboard, resulting in wiping out anything I had typed onto a document. I quickly learnt to frequently hit the save button.

 

My surgery yesterday was done under general anaesthetic and took about an hour. I was able to come home the same day. My stitches have to stay in for 2 weeks, then a have a review appointment. I can start driving once the stitches are removed. The surgeon predicts I can probably use a chainsaw in 4 weeks, and resume climbing in 6 weeks, which I think is pretty promising.

 

I hope that I can get some gel filled fingerless gloves, like cycling gloves, to finger under my normal work gloves to reduce the vibration my hands are exposed to once I am back at work. 

 

 

I will update on progress and recovery in due course ..... unless you all tell me to stop being boring that is.

[rapalaman]

Best of luck with your recovery 👍

the part where you said you’d added pictures shortly after saying it affects the penis had me dreading scrolling down I have to say 😂

[Steve Bullman]

14 minutes ago, maybelateron said:

it can affect the feet, and rarely present as Peyronie's disease, affecting the penis

 

15 minutes ago, maybelateron said:

the tissue layer between the skin and the deeper layers of muscle and bone becomes thickened with excessive collagen

Pretty sure I must have that.

 

joking aside, thanks for sharing and I hope the operation helps!

[maybelateron]

2 minutes ago, rapalaman said:

the part where you said you’d added pictures shortly after saying it affects the penis had me dreading scrolling down I have to say 😂

Mine isn't affected I am pleased to say, but it is so small in this cold weather it would be invisible. 

[Mick Dempsey]

I remember you talking about this a week or so back.

I have it, but much much less advanced than you on my left hand.

Was only you mentioning it diagnosed it for me.

[5thelement]

I’m pretty sure Margaret Thatcher had the same operation .It was the ‘hands turning into a claw’ that jogged my memory, she kept the horns and tail well hidden though.

[maybelateron]

2 hours ago, Mick Dempsey said:

I remember you talking about this a week or so back.

I have it, but much much less advanced than you on my left hand.

Was only you mentioning it diagnosed it for me.

I think you mentioned this previously after my first post. I know you hit the big 60 not that long ago, and I wonder if it might not progress too quickly if you don't do too many more years on the tools. One other option with an early case might be wearing a splint at night, but I don't know the success rates of this. Another newer treatment, I think for early cases, is injecting an enzyme into the area that will break down the collagen, then a day or so later having your hand pulled straight to stretch the fibrous tissue. Hope yours stays dormant for you.

[aswales]

radiotherapy is another option in earlier stages, have a look at the this website and also the work of Dr John Glees

 

https://dupuytrens-society.org.uk/treatment-2/dupuytrens-disease/radiotherapy-treatment/

 

it runs in families as well as being aggrevated by occupation...

[roboted]

I turned down the op(s) in 2015 as I couldn't afford the recovery time whilst trying to get back into work. I was told then, 8 to 10 weeks a paw with no driving for 4 to 6 weeks.

A year later I sorted out my retirement plan and so at 61 i did. Left it and now I can't even get onto a waiting list with our local health system. 

Hey ho, adapt and improvise 

 

@maybelateron Hope your recovery  goes well, don't rush it !

[Mick Dempsey]

21 hours ago, maybelateron said:

I think you mentioned this previously after my first post. I know you hit the big 60 not that long ago, and I wonder if it might not progress too quickly if you don't do too many more years on the tools. One other option with an early case might be wearing a splint at night, but I don't know the success rates of this. Another newer treatment, I think for early cases, is injecting an enzyme into the area that will break down the collagen, then a day or so later having your hand pulled straight to stretch the fibrous tissue. Hope yours stays dormant for you.

As it stands, I have no pulling in of the fingers, so it’s just a lump, been there more than 20 years iirc.

I had just thought it was a callous till you talked about it.