Depuytren's Disease and Climbing

Hey MP,

Depuytren's Disease runs in my family and although I'm only 31, I'm pretty sure i'm developing a nodule in my right palm's ring finger tendon (i.e. the most common spot). I was really hoping to wait until my 50s to do battle with this congenital inconvenience; bad luck.

I know there's several treatment options from surgery, injections, and I even heard radiation works (especially in the early stages, like mine). I'm curious if any other climbers who've had experience with Depuytren's would be willing to weigh-in on the treatment options and their respective recovery tracks.

• If you had surgery- how long was the recovery? how long were you unable to climb? has there been any lasting affect on your climbing- any loss of sensation or strength?
• If you got injections, did the nodule/cord go away completely? did it shrink? is this more noninvasive approach preferrable for climbers?
• Anyone get radiation to shrink the calcified tendon(s)?

I've done some internet scouring and read several MP threads (so I'm basically a licensed hand specialist now), but couldn't find conclusive answers to the above questions, hence me posting here.

Thanks!

A few threads in the "Injuries" forum

Help!!!!! Lump in palm, possible pulley injury? or Dupuytren's?

Dupuytren's disease

yeah, thanks! i read those and I emailed Mark H., who folks have recommended reaching out to.

some swear by the enzyme injection (Candace, who has posted detailed responses) while others say it's just delaying the inevitable (i.e. surgery) and that if you get it removed early, you don't risk any permanent loss of range of motion (like my dad and his pinky). 

I have large nodules on both palms (ring finger tendon).  So far they are not an issue for me. I do feel them while working slopers.  That and if I slip off a sloper too much it rubs hard on the bump. This makes them get torn up easy.  My Dr. says as long as I have full motion and no pain not to worry.  

sweet! thanks for sharing. Mine has no cord yet or anything and is totally painless and hasn't grown, but I LOVE climbing and am leery to wait until I'm affected to do something about it, especially because I have great insurance right now.

As i eluded to above, my 66 yr old dad lost about 10% of range of motion in his pinky after his most recent (3rd total) Depuytren's surgery, and it may be because he let it get too big before operating (his second surgeon contradicted his first surgeon, who had told him to wait until it bends the finger and becomes an issue)

Gosh Glance wrote:

sweet! thanks for sharing. Mine has no cord yet or anything and is totally painless and hasn't grown, but I LOVE climbing and am leery to wait until I'm affected to do something about it, especially because I have great insurance right now.

As i eluded to above, my 66 yr old dad lost about 10% of range of motion in his pinky after his most recent (3rd total) Depuytren's surgery, and it may be because he let it get too big before operating (his second surgeon contradicted his first surgeon, who had told him to wait until it bends the finger and becomes an issue)

I often feel I should get a second opinion about the waiting for issue.  But there is a slight ignorance is bliss aspect to it.  If you find out anything feel free to post. I will do the same if anything changes on my end.  

Nodules showed up a couple years ago and I got really worried and read all the threads.... and then they just stopped growing. They're still there, they just haven't changed. So that might happen to you. Don't panic until it's time to panic.

subscribed: I just had a nodule show up a couple of months ago. No pain, have full range of motion, but I can feel that it's there if I grab something. Going to be seeing a doctor about it soon and I can report back.

So I am 60. My first operation on both hands happened when I was 30. Avoid any correction that requires surgery as long as you can as it is a long recovery period....2 to 5 months.

I am about to undergo collagen bond injections, somthing that was not avaiable my first time around. I am told that I will be able to ease back into the rock after 2 weeks. 

Don't worry about the nodules until your fingers curl enough to affect what you want to do. The only reason I am doing it now is my fingers have curled enough that I can't easily clean gear placed in cracks.

One more thing. Shop around for the right Doctor. You want an accomplished hand Dr. who is up on all the latest options and who has good skills if your only choice is surgery.

Nkane 1 wrote:

Nodules showed up a couple years ago and I got really worried and read all the threads.... and then they just stopped growing. They're still there, they just haven't changed. So that might happen to you. Don't panic until it's time to panic.

the disease has active and dormant phases that can last for years (even decades).

I had Dupuytren's on one hand.  It got to the point where my pinkie could not straighten out more than a 45 degree bend.  A hand specialist did a Needle Aponeurotomy on me.  It took about 20 minutes.  I had to wear a small bandage for a few days.  I was climbing 3 days later.  The hand was straight immediately after the surgery.  And it is still straight today which is a few years later.

 I would compare the Needle Aponeurotomy to donating blood.  They both take about the same amount of time and discomfort.  It is a very low risk out patient procedure.

I can't personally speak to the other options, but surgery worked good for me.  About 20 years ago now.  The rehab seemed pretty quick, I started climbing after 4 weeks and was able to do reasonably hard stuff quickly.  I suspect rehab time can/will vary, my wife is a PT (rehab taskmaster, haha.)  The surgery didn't result in any range of motion loss but I did have some loss of feeling at the tip of my little finger that took a while to return.

Prior to having it done my left ring and little finger were getting bad really quick (super-hyper-active phase?)  The more the fingers became claws it seemed the quicker I got pumped.  Got tired of getting pumped all the time, had surgery, no regrets. 

My wife researched doctors and found the best one she could.  It hasn't come back at all and I climb a lot, so if the decision is surgery I definitely agree with and second this recommendation >>>  "One more thing. Shop around for the right Doctor. You want an accomplished hand Dr. who is up on all the latest options and who has good skills if your only choice is surgery."

fwiw: Surgery is intrusive and I'm not arguing for it, but it did turn out good for me.  I know a couple of people who had Needle Aponeurotomy and it came back quickly (although I have also heard good reports.) From what I understand (and I was warned before surgery) it can frequently recur regardless of treatment.  Maybe research the recurrence rates of the various procedures?  If surgery statistics show it's (enough) better at preventing/delaying return I might factor that in.  Then again, if the needle treatments are only like giving blood maybe repeat treatments, if needed, aren't so bad. 

Darn those Vikings.  Seems like they spread it everywhere they went, or so I've been told.

Darrell Hensel wrote:

I can't personally speak to the other options, but surgery worked good for me.  About 20 years ago now.  The rehab seemed pretty quick, I started climbing after 4 weeks and was able to do reasonably hard stuff quickly.  I suspect rehab time can/will vary, my wife is a PT (rehab taskmaster, haha.)  The surgery didn't result in any range of motion loss but I did have some loss of feeling at the tip of my little finger that took a while to return.

Prior to having it done my left ring and little finger were getting bad really quick (super-hyper-active phase?)  The more the fingers became claws it seemed the quicker I got pumped.  Got tired of getting pumped all the time, had surgery, no regrets. 

My wife researched doctors and found the best one she could.  It hasn't come back at all and I climb a lot, so if the decision is surgery I definitely agree with and second this recommendation >>>  "One more thing. Shop around for the right Doctor. You want an accomplished hand Dr. who is up on all the latest options and who has good skills if your only choice is surgery."

fwiw: Surgery is intrusive and I'm not arguing for it, but it did turn out good for me.  I know a couple of people who had Needle Aponeurotomy and it came back quickly (although I have also heard good reports.) From what I understand (and I was warned before surgery) it can frequently recur regardless of treatment.  Maybe research the recurrence rates of the various procedures?  If surgery statistics show it's (enough) better at preventing/delaying return I might factor that in.  Then again, if the needle treatments are only like giving blood maybe repeat treatments, if needed, aren't so bad. 

Darn those Vikings.  Seems like they spread it everywhere they went, or so I've been told.

My dad has it come back about every 5 years; he's had 3 surgeries. Most recent one resulted in some loss of feeling in his pinky finger as you describe, but the feeling never came back.. or at least it hasn't yet and it's been a few years. he said it's not like pins and needles numb, just doesn't feel like anything. I'd be willing to bet I have a similar case. We're Hungarian, so not sure how we got Viking blood in us.

i think i'd get surgery but the needle might be worth trying first. I'm pretty diligent when it comes to pt stuff so that's good to hear.

as for a hand doctor, Seattle Hand Group is the place I'd go. I broke my arm really really bad when i was six (almost lost my right arm from the elbow down), but they saved it. They were the ones that did Ken Griffey Jr.'s wrist and they've got my business for life. In college they also removed an infected tissue cyst from my palm (stabbed myself opening an oyster)- they did a similarly fantastic job

Thanks!

[Sorry for cross-posting] Has anyone pursued the enzyme injection route? I know it stops the disease from progressing, it breaks down the cords and is much cheaper... but I assume it does nothing to reduce the size of the nodule- is that correct? In other words, only surgery will get rid of the bump?

I've got a fast progressing case; it only hurts on sharp holds that jab directly into it, but yesterday, a gym sloper gave me a gnarly flapper on my palm right where the bump is. I have 0% contracture, so if my above assumption is correct, the enzyme injection would be pointless in preventing future flappers.

I have an amazing hand surgeon that I recently reconnected with, but he's out-of-network for 2021, so I was really hoping to hold off until 2022 so I can switch up my insurance. i had no qualms waiting before the bump started giving me flappers...

Climbing is my religion- and I'm devout- so your further insight would be greatly appreciated.

Gosh Glance wrote:

Climbing is my religion- and I'm devout- so your further insight would be greatly appreciated.

I think people in religions pray at this point?

Honestly this seems like it would absolutely blow, best of luck. To your prior post, the one upside to losing some of the feeling in my thighs is that I am probably the best person I know at knee baring so maybe you can become a master of pinky locking. 

Gosh Glance wrote:

[Sorry for cross-posting] Has anyone pursued the enzyme injection route? I know it stops the disease from progressing, it breaks down the cords and is much cheaper... but I assume it does nothing to reduce the size of the nodule- is that correct? In other words, only surgery will get rid of the bump?

I've got a fast progressing case; it only hurts on sharp holds that jab directly into it, but yesterday, a gym sloper gave me a gnarly flapper on my palm right where the bump is. I have 0% contracture, so if my above assumption is correct, the enzyme injection would be pointless in preventing future flappers.

I have an amazing hand surgeon that I recently reconnected with, but he's out-of-network for 2021, so I was really hoping to hold off until 2022 so I can switch up my insurance. i had no qualms waiting before the bump started giving me flappers...

Climbing is my religion- and I'm devout- so your further insight would be greatly appreciated.

i had a consultation with a hand specialist a few years ago.  his take was that the enzyme injection was pretty worthless, the needle therapy (his specialty) worthwhile, and the surgery higher risk, but potentially highly effective (with the big caveat that the surgeon needs to be highly skilled/successful).  anecdotally, a former coworker of mine had unsuccessful surgery on both hands.

old5ten wrote:

i had a consultation with a hand specialist a few years ago.  his take was that the enzyme injection was pretty worthless, the needle therapy (his specialty) worthwhile, and the surgery higher risk, but potentially highly effective (with the big caveat that the surgeon needs to be highly skilled/successful).  anecdotally, a former coworker of mine had unsuccessful surgery on both hands.

Weird, the specialist I saw said the opposite- he refuses to do the needle to outrageously high recurrence rate on the same nodule and only does injections since they do recur, but rarely on the same tendon. He agreed about the surgery being risky unless the surgeon knows what they're doing. His name is Dr. William Wagner, and he does thousands of enzyme injections per year, and hundreds of surgeries, including several successful ones on my dad and stepmom the last 20 years.

Keep the feedback comin' !!

Howdy o/

I am the guy who set up RPU, Redpoint University Climbers Forum after ST went dark.   I eschew "poaching" users from other forum sites cuz it just ain't cool.  Also believe in eating your own dog food.  Hence I never created an account here, even when prompted to do so during that MP/REI bruhaha a while back.

So wtf am I here now?  Well... I have a "fairly aggressive" form of Dupuytrens Disease.  I'm private and would like to be employed again someday so never  posted up about it.  Until last December over on  RPU.  

Here's a couple threads:

https://forums.redpointuniversity.com/topic/381/dupuytren-s-foundation

https://forums.redpointuniversity.com/topic/390/dupuytren-s-thread/8

I have had several needle aponverotomy (sp?).  Also three z-plastcie (sp?).   About six weeks out from my last surgery - typing this mostly one handed now.  I'll update that second thread above with some fresh pics in not too distant future.  I won't be posting up much here so drop on into RPU if you would like to discuss further.

In meantime, I refer you to Dr. Charles Eaton, a pioneer hand surgeon specializing in this crud.  He's since retired from practice and channels his energies into the Dupuytren's Foundation, which he founded to support Dupuytrens research.  Big project being the Dupuytrens Disease Databank; objective being to get this genetically mapped so we can start focusing more on underlying causation rather than mere wash, rinse, and repeat short term fixes.

https://dupuytrens.org/homepage/

Dr. Eaton has really fleshed the site out in recent years  with videos, articles, etc.  Tons of info there to help you separate the chaff from the wheat.

Just a quick plug for the study before I close: they have enough folks who have the  disease (I am one) but lack requisite control group who do not.  At least last I checked.  So be cool if some of y'all rock jock types who do not could take a gander and consider participating.

Well, this is getting long winded.  Probably lots of typos too.

Hope this is useful/helpful. 

Good luck.

P.S.; To whomever posted up that pic... sad to be the bearer of bad news but... in words of BTO; "You ain't see nuthin' yet..."

P.P.S; I followed the enzyme from early test cuz it looked real promising.  Alas, I would strongly discourage that route.  Too much to try to type one handed so you'll have to take my word or do your own research.  Ditto the radiation therapy option even though the doc that did my needle jobs (he has it too) reported very favorable results.  He had mild but recurring form, fwiw.

P.P.P.S; !Aye, Caramba!!   Yet one more "last thing". There are also some Dupuytrens forums hosted in EU (Germany, iirc, but I forget their name).  Ah, yeah, International Dupuytrens Society:

https://www.dupuytren-online.info/Forum_English/index.php

Been several years since I browsed there - Lots of victims there sharing.  Maybe worth a search.

Burnin Vernon wrote:

Howdy o/

I am the guy who set up RPU, Redpoint University Climbers Forum after ST went dark.   I eschew "poaching" users from other forum sites cuz it just ain't cool.  Also believe in eating your own dog food.  Hence I never created an account here, even when prompted to do so during that MP/REI bruhaha a while back.

So wtf am I here now?  Well... I have a "fairly aggressive" form of Dupuytrens Disease.  I'm private and would like to be employed again someday so never  posted up about it.  Until last December over on  RPU.  

Here's a couple threads:

https://forums.redpointuniversity.com/topic/381/dupuytren-s-foundation

https://forums.redpointuniversity.com/topic/390/dupuytren-s-thread/8

I have had several needle aponverotomy (sp?).  Also three z-plastcie (sp?).   About six weeks out from my last surgery - typing this mostly one handed now.  I'll update that second thread above with some fresh pics in not too distant future.  I won't be posting up much here so drop on into RPU if you would like to discuss further.

In meantime, I refer you to Dr. Charles Eaton, a pioneer hand surgeon specializing in this crud.  He's since retired from practice and channels his energies into the Dupuytren's Foundation, which he founded to support Dupuytrens research.  Big project being the Dupuytrens Disease Databank; objective being to get this genetically mapped so we can start focusing more on underlying causation rather than mere wash, rinse, and repeat short term fixes.

https://dupuytrens.org/homepage/

Dr. Eaton has really fleshed the site out in recent years  with videos, articles, etc.  Tons of info there to help you separate the chaff from the wheat.

Just a quick plug for the study before I close: they have enough folks who have the  disease (I am one) but lack requisite control group who do not.  At least last I checked.  So be cool if some of y'all rock jock types who do not could take a gander and consider participating.

Well, this is getting long winded.  Probably lots of typos too.

Hope this is useful/helpful. 

Good luck.

P.S.; To whomever posted up that pic... sad to be the bearer of bad news but... in words of BTO; "You ain't see nuthin' yet..."

P.P.S; I followed the enzyme from early test cuz it looked real promising.  Alas, I would strongly discourage that route.  Too much to try to type one handed so you'll have to take my word or do your own research.  Ditto the radiation therapy option even though the doc that did my needle jobs (he has it too) reported very favorable results.  He had mild but recurring form, fwiw.

P.P.P.S; !Aye, Caramba!!   Yet one more "last thing". There are also some Dupuytrens forums hosted in EU (Germany, iirc, but I forget their name).  Ah, yeah, International Dupuytrens Society:

https://www.dupuytren-online.info/Forum_English/index.php

Been several years since I browsed there - Lots of victims there sharing.  Maybe worth a search.

there's a lot to unpack here but i'm not sure any of it helps me answer my question. WILL THE ENZYME SHRINK AND/OR ELIMINATE MY NODULE(S)?.. or will it just hold the disease at bay? I know for folks who's fingers have contracted, it has shown great results for doctors to ~48 hours after injection stretch your fingers straight again.

Gosh Glance wrote:

Weird, the specialist I saw said the opposite- he refuses to do the needle to outrageously high recurrence rate on the same nodule and only does injections since they do recur, but rarely on the same tendon. He agreed about the surgery being risky unless the surgeon knows what they're doing. His name is Dr. William Wagner, and he does thousands of enzyme injections per year, and hundreds of surgeries, including several successful ones on my dad and stepmom the last 20 years.

Keep the feedback comin' !!

one thing that the doc in my consultation emphatically emphasized was that whatever treatment path you choose, the treatment should happen during a non-active/dormant phase.

Why is that?  Did your Dr. say?