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#328455 - 01/26/06 12:01 PM Re: Lump in the palm of the hand.
Cobra_Commander Offline
spray'prentice

Registered: 01/31/05
Posts: 3342
TRs: 0 Photos: 6
Loc: Lair
that sucks to hear. at least it's not an alien baby.
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#328456 - 01/26/06 12:06 PM Re: Lump in the palm of the hand.
catbirdseat Offline
Elite Sprayforce Team

Registered: 10/09/02
Posts: 13215
TRs: 46 Photos: 144
Loc: Costa Mesa, CA
I credit you with allowing me to look on the bright side.
_________________________
You don't do an encore if you just played Mahler.

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#328457 - 01/26/06 12:07 PM Re: Lump in the palm of the hand.
Alpinfox Offline
Tebow Believer

Registered: 03/05/02
Posts: 5220
TRs: 22 Photos: 320
I have a Dupuytren's contracture in my right palm between my ring and pinky fingers. It is painless and has only a very minor impact on extension of my ring+pinky fingers. It happened while climbing in the gym and I experienced a minor "pop" sound and sensation, though it was painless.

I talked with Dr. Hanel (the hand surgeon at Harborview mentioned above) about it while seeing him for another tendon injury and he confirmed that diagnosis. He also said that DCs CAN and DO occur following trauma, especially in climbers (in fact he has one himself) and that they may, or may not progress with age.

Basically, they are no big deal. You might try some massage and stretching to try to relax and extend the collagenous fibers.

You might want to get a second opinion and rule out the alien baby issue; that's a commonly misdiagnosed condition frequently overlooked in the differentiall diagnosis by even the best hand specialists.
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#328458 - 01/26/06 12:13 PM Re: Lump in the palm of the hand.
catbirdseat Offline
Elite Sprayforce Team

Registered: 10/09/02
Posts: 13215
TRs: 46 Photos: 144
Loc: Costa Mesa, CA
Supposedly, it is a Scandinavian/ Northern European disease. I am unaware of any Scandahoovian ancestors, but those Vikings had a habit of spreading their genes around, so I probably got a dose through a Norman ancestor.
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You don't do an encore if you just played Mahler.

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#328459 - 01/26/06 01:41 PM Re: Lump in the palm of the hand.
crackers Offline
old hand

Registered: 01/03/06
Posts: 769
TRs: 0 Photos: 9
Loc: PDX
I have DC in both hands. I am 31, and honestly its not a big deal yet. I highly recommend massaging them a lot, which i was told to do by our relatives still over in norway/sweden. Take your thumb and massage the area from the base of the hand to the finger with deep massage. I do this every couple of days.

You will know pretty damn quick when it's gone bad. You'll have a twisted lump of a hand. Your skin will seem to make a little twist and your two fingers at the end of your hand will be ratcheted down. They won't extend any more, and it'll be really painful. Just before that, you'll do something with lots of vibration--run a chainsaw or go mtbiking--and you won't be able to open your hand for three or four hours.

DC sucks. hope for a misdiagnosis. It tends to be hereditary, so ask any living relatives if they have it or remember somebody who had it. My mother, her brother and sister, her father, his father and his brothers all had it.

Sorry dude.

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#328460 - 01/26/06 02:06 PM Re: Lump in the palm of the hand.
DirtyHarry Offline
spray'prentice

Registered: 07/28/04
Posts: 3571
TRs: 5 Photos: 44
Quote:

I have DC in both hands.




That's 'cause you're a cracker. Cracker.
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#328461 - 01/26/06 02:22 PM Re: Lump in the palm of the hand.
catbirdseat Offline
Elite Sprayforce Team

Registered: 10/09/02
Posts: 13215
TRs: 46 Photos: 144
Loc: Costa Mesa, CA
No relatives have had it that I know of. That's the unusual thing about this. I'm wondering whether this was set off by a month long course of fluoroquinolone antibiotics I took a couple year ago. They are known to cause damage to tendons and any tissue that contains collagen.
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You don't do an encore if you just played Mahler.

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#328462 - 01/26/06 02:35 PM Re: Lump in the palm of the hand.
Alpinfox Offline
Tebow Believer

Registered: 03/05/02
Posts: 5220
TRs: 22 Photos: 320
MORE INFO

"Collagenase percutaneous needle fasciotomy is currently undergoing clinical trials. Preliminary results by Badalamente and Hurst show an astonishing results of more than 90% correction of MCP joint, 66% correction of the PIP joint, and minimal recurrence rates. Adverse effects include pain at injection site, minimal swelling, and hematoma. Although collagenase is showing promise in clinical trials, surgery is still considered the criterion standard for a cure."
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#328463 - 01/26/06 03:20 PM Re: Lump in the palm of the hand.
catbirdseat Offline
Elite Sprayforce Team

Registered: 10/09/02
Posts: 13215
TRs: 46 Photos: 144
Loc: Costa Mesa, CA
Yes, I am aware of that trial. It's encouraging. At present, I can afford to bide my time and wait for the results and for clinicians to gain more experience with the treatment.
_________________________
You don't do an encore if you just played Mahler.

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#328464 - 01/26/06 11:11 PM Re: Lump in the palm of the hand.
layton Offline
sprayer

Registered: 11/27/00
Posts: 7420
TRs: 39 Photos: 811
Loc: Stony Brook, NY
Sure it's not a ganglion cyst CBS? Very odd to get DC without having a male on your side of the family (dad, granddad) with it. If it is, avoid surgery (although many need it) because it is recurrent, and the more times you get surgery, the harder it is to get in there. Basically by the 3rd surgery it's a friggin mess in there and you're stuck. Same goes with steroid injections. Yes, the 1st one may wipe it out, but after a few, you've totally f'd up you hand and it's not worth the penalty.

Stretch it, aggresively (i.e. by someone else than you) massge it, heat it, parafin bath, do research. nip it in the bud.

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#328465 - 01/26/06 11:14 PM Re: Lump in the palm of the hand.
layton Offline
sprayer

Registered: 11/27/00
Posts: 7420
TRs: 39 Photos: 811
Loc: Stony Brook, NY
try cold laser!!! or the type of ultrasound they use to destroy kidney stones (has a funky name, forgot). that type of ultrasound is sometimes used in very chronic plantar fascitits and has a very high recovery rate after about 6m to 1 year. Look into it, even if your doctor doesn't mention it. I'll look it up if you are interested.

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#328466 - 01/27/06 07:36 AM Re: Lump in the palm of the hand.
EWolfe Offline
Spray Master

Registered: 04/21/03
Posts: 10567
TRs: 3 Photos: 559

She’s lump she’s lump
She’s in my palm
She’s lump she’s lump she’s lump

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#328467 - 01/27/06 07:57 AM Re: Lump in the palm of the hand.
Off_White Offline

Capricious Warlord

Registered: 04/04/02
Posts: 9207
TRs: 22 Photos: 353
Loc: Tenino
I had a lump on the inside of my left wrist, near the base of the thumb. Pointy kind of lump, like something poking out, and I could make it more dramatic by bending my wrist. It would go away by rubbing it, but come back. I named it "Ripley" and used it to gross out my 14 year old daughter. I noticed a few weeks ago that Ripley was gone without a trace, I miss her.

I've also got some right hand tendon problems, ring and pinky finger, (fucking gym pockets) but I finally get in to see the hand doc next week.

It's a little sick, but it is reassuring to hear of everyone else's ailments. At least I don't have whatever it is that ails MisterE.
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#328468 - 01/27/06 08:44 AM Re: Lump in the palm of the hand.
catbirdseat Offline
Elite Sprayforce Team

Registered: 10/09/02
Posts: 13215
TRs: 46 Photos: 144
Loc: Costa Mesa, CA
Quote:

try cold laser!!! or the type of ultrasound they use to destroy kidney stones (has a funky name, forgot). that type of ultrasound is sometimes used in very chronic plantar fascitits and has a very high recovery rate after about 6m to 1 year. Look into it, even if your doctor doesn't mention it. I'll look it up if you are interested.


I heard of that. It's similar to lithotrypsy and not many doctors are even aware of it yet. If it works on feet, it might work on hands.

Anyway, I plan to get an ultrasound to find out for sure if there are cysts. Ultrasound is good at detecting fluid-fill cavities. Icegirl warned me that not all hand doctors are able to make an accurate diagnosis. I should have taken her advice to see Dr. Hanel. Regardless, the ultrasound will tell.
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You don't do an encore if you just played Mahler.

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#328469 - 01/27/06 04:34 PM Re: Lump in the palm of the hand.
layton Offline
sprayer

Registered: 11/27/00
Posts: 7420
TRs: 39 Photos: 811
Loc: Stony Brook, NY
The thing with the hand doctors (and everyone else, including chiros!!) is that if you're tool is a hammer, you're gonna find some nails to pound.

Suggest the ultrasound lithotrypsy-like procedure to your hand specialist and let me know what he/she says. I just made that idea up while reading your complaint, so it would be interesting to see if it is a good idea.

Keep me updated here, or via PM's so I can use this info for my patients.

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#328470 - 01/27/06 04:56 PM Re: Lump in the palm of the hand.
tivoli_mike Offline
enthusiast

Registered: 11/14/00
Posts: 334
TRs: 6 Photos: 17
Loc: Seattle
Quote:

Supposedly, it is a Scandinavian/ Northern European disease. I am unaware of any Scandahoovian ancestors, but those Vikings had a habit of spreading their genes around, so I probably got a dose through a Norman ancestor.




Yep, comes down in my father's family ( Dutch and then Normandy )... having seen anything yet , but my father starting showing it in his 50s so hopefully I have a few years.
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#328471 - 02/03/06 06:43 PM Re: Lump in the palm of the hand.
dylan_taylor Offline
enthusiast

Registered: 01/23/04
Posts: 285
TRs: 4 Photos: 184
Loc: on somebody's couch
I showed my hands to a hand doc in boulder a year ago. Definetly dupuytrens for me. I've got a large lump midway up the palm on each hand, over the ring finger tendon. Below the lumps, stretching towards my wrists, my tendons are elevated. my ring fingers are contracting and I have very poor flexibility of the whole hand. I can barely get my palm flat on a table and it is uncomfortable.

The doctor said he's never seen it in someone so young (I am 30).

Usually, he says, he sees them in people in their 50's and 60's. He says he keeps up on the literature of this particular disease because he has the gene (family hx) and he knows he's gonna get it. But his advice is often opposite of what I read in the above link. he was telling me "not to stretch or massage it - it'l only make it worse" he says. I don't know if he's full of it or not. Although he did say a lot of the same things you said mike: once surgery is performed, it progresses into second-stage dupuytrens - which progresses faster. He said surgery, though effective, would only last 5-6 years, and it would be like "pulling bubble gum out of a shag carpet".
I recently heard that there was a paper published by some european doctors studying sports related injuries in young european sport climbers. A client told me about it. I wish I could get my (steadily warping) hands on it. Apparently, there are frequent cases of dupuytrens in young euro sport climbers who climb a ton and get overuse injuries. Sort of goes along with what that link stated and what some people here are saying. . I do not know if there is a genetic link to those cases, or if it is simply from climbing/training overuse.


Edited by dylan_taylor (02/03/06 07:06 PM)

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#328472 - 02/03/06 06:59 PM Re: Lump in the palm of the hand.
JosephH Offline
sprayer

Registered: 08/11/04
Posts: 5491
TRs: 1 Photos: 470
Loc: PDX
I went to college with two guys that grew up fanatical barefoot waterskiers who also used part of a hickory axe handle for the ski rope handle. They were incredible at barefooting way back in the day but both developed bad ganglion cysts all over their hands and feet and have had to have them removed about once a decade so far. Catbird, your's unfortunately does sound more like DC and hope you manage to stay in action for a long time regardless...

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#328473 - 06/20/06 09:51 AM Re: Lump in the palm of the hand.
catbirdseat Offline
Elite Sprayforce Team

Registered: 10/09/02
Posts: 13215
TRs: 46 Photos: 144
Loc: Costa Mesa, CA
Through my work as a chemist, I have learned about a drug, approved in Japan, but not in the US, called Tranilast (rizaben), which is used to treat allergic diseases. It is an inhibitor of mast cell degranulation and it also inhibits Basic Fibroblast Growth Factor bFGF, which is involved in collagen synthesis.

The drug has been used experimentally in preventing keloid scarring and in restenosis, which is the reclosing of arteries following angioplasty. There are reports of the drug being effective in scleroderma, a skin disorder involving scar-like contractures.

The drug has orphan drug status in the US for malignant glioma, a brain tumor.

It has occurred to me that this drug might, in fact, be useful in the treatment of Dupuytren's Contracture. I've heard from fellow scientists that the safety profile of this drug is quite good. That is in keeping with what I know about the Japanese drug regulators. There, safety is first, and efficacy is secondary. Of course, Japan has lots of approved drugs that don't work.

Does anyone know if it is possible to get drugs like this in the US?
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You don't do an encore if you just played Mahler.

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#328474 - 07/27/06 05:27 PM Re: Lump in the palm of the hand.
Crux Offline
veteran

Registered: 08/24/03
Posts: 1373
TRs: 0 Photos: 0
Loc: Way, way off route
Quote:

I have a Dupuytren's contracture in my right palm between my ring and pinky fingers. It is painless and has only a very minor impact on extension of my ring+pinky fingers. It happened while climbing in the gym and I experienced a minor "pop" sound and sensation, though it was painless.

I talked with Dr. Hanel (the hand surgeon at Harborview mentioned above) about it while seeing him for another tendon injury and he confirmed that diagnosis. He also said that DCs CAN and DO occur following trauma, especially in climbers (in fact he has one himself) and that they may, or may not progress with age.

Basically, they are no big deal. You might try some massage and stretching to try to relax and extend the collagenous fibers.



Nope... stretching exercises are known to exacerbate the condition if anything. Been there, did that. Stopped doing it when second opinion told me I was making things worse.

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#328475 - 07/27/06 05:48 PM Re: Lump in the palm of the hand.
Crux Offline
veteran

Registered: 08/24/03
Posts: 1373
TRs: 0 Photos: 0
Loc: Way, way off route
Quote:

Yes, I am aware of that trial. It's encouraging. At present, I can afford to bide my time and wait for the results and for clinicians to gain more experience with the treatment.



Fwiw, the collagenase trials are going nowhere.

Moreover, a radical fasciectomy, the intervention typically practiced by most U.S. hand surgeons for Dup's, is very traumatic, causes disfigurement, and requires months of painful post-op recovery to restore use of the hand. (It also requires an operating room and surgical staff.)

But you will probably have to do something sooner than later, else see your climbing career done a lot sooner than later and what else. The contracture typically progresses, sometimes quickly, sometimes slowly. If you don't really use your hands, then you can probably get by until the day you find you can't release the steering wheel of your car. After that, the contracture can get to the point where it starts driving your fingernails into your hand, but the doctor who told me that confided he only had to amputate the fingers in the case of a demented elderly woman who apparently didn't notice or care that she couldn't climb rocks or drive cars anymore.

Anyway, an alternative procedure for treating Dupuytren's was recently developed in Europe and for most persons who require Tx for the contractures it's probably a superior option. Called a needle aponevrotomy, it's an outpatient procedure that produces minimal trauma-- the patient is good to go in a matter of hours -- and over the past few years several clinics that offer the procedure in the U.S have been established.

Treatment with the NA requires around twenty minutes. That's it. It might cost about the same as a root canal, but it takes less time and probably doesn't hurt nearly as much after the local wears off. In contrast, the recovery time, medical costs, and risks that are involved with aradical fasiectomy are greater by a magnitude.

Based on what I've learned, the needle aponevrotomy for Duypuytren's is sort of like using orthoscopic surgery for the knee in contrast to taking the whole joint apart to remove an offending bit of cartilidge.



Attachments
590824-dupuytren\'s.gif (369 downloads)


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#328476 - 07/27/06 08:41 PM Re: Lump in the palm of the hand.
dmuja Offline
old hand

Registered: 07/18/03
Posts: 869
TRs: 0 Photos: 14
Loc: WESS SEA
Quote:

I have a Dupuytren's contracture in my right palm between my ring and pinky fingers. It is painless and has only a very minor impact on extension of my ring+pinky fingers. It happened while climbing in the gym and I experienced a minor "pop" sound and sensation, though it was painless.

I talked with Dr. Hanel (the hand surgeon at Harborview mentioned above) about it while seeing him for another tendon injury and he confirmed that diagnosis. He also said that DCs CAN and DO occur following trauma, especially in climbers (in fact he has one himself) and that they may, or may not progress with age.

Basically, they are no big deal. You might try some massage and stretching to try to relax and extend the collagenous fibers.

You might want to get a second opinion and rule out the alien baby issue; that's a commonly misdiagnosed condition frequently overlooked in the differentiall diagnosis by even the best hand specialists.





Yea! Now I got a name for the lump just blow the ring finger of my right hand! (tnx for da updated thread)

I thought it was just a small ruptured tendon or sumpin. I used to just say "its a lump".

Mine seemed to appear over night also, but it may have been that I "suddenly" noticed it. I gave climbing a rest for a while but it didn't get any better or go away so I decided to just basically ignore it. After doing bar pull-ups or 30Lb dumbell curls it seemed to be smaller (almost like it got "pushed" back in place). It sorta comes and goes a little.

It doesn't hurt, but now that it has a name, it probably will start hurting.

On second thought, I'm gonna forget about the name and just go back to calling it "a lump". That way I won't be making up some lame assed excuses for not climbing, nor forming any "DC" support groups, nor saddly ponder my hopeless future as a "victim" of DC etc.. etc.. bla bla.., demand my rights as a DC survivor etc..


Oh for the good old days when people just toughed it out, or died of shit like "the Kroup" or "ol'age".

PS - Do you have occasional pain in your legs? You may have RLS "restless leg syndrome"

D
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#328477 - 07/28/06 08:22 AM Re: Lump in the palm of the hand.
catbirdseat Offline
Elite Sprayforce Team

Registered: 10/09/02
Posts: 13215
TRs: 46 Photos: 144
Loc: Costa Mesa, CA
My nodule has not progressed significantly in the past several months. I still have full function. I can afford to bide my time at this point.
_________________________
You don't do an encore if you just played Mahler.

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#328478 - 07/29/06 04:57 PM Re: Lump in the palm of the hand.
Crux Offline
veteran

Registered: 08/24/03
Posts: 1373
TRs: 0 Photos: 0
Loc: Way, way off route
It's a no-brainer to avoid the slice-and-dice if you suffer no disability. By definition, your contracture is only Stage 0 and docs advise you do nothing until stage 1 or 2. I'd tell you my own Hx with Dup's, but anecdotal information won't help because the manifestations and progression of the disease vary greatly from individual to individual. Sufficient to say that I first noticed a nodule from the painful pressure spot it created on my palm when grabbing rock. Now have stage 2 contracture at metacarpal phalangeal joint at one pinky, but it took a long time to come to that. It's more common than you might think, and although it's directly inherited it often does not present detected manifestations. Therefore, one or both of your parents have it, even though it may not have been noticed. Your case evidently is quite noticable, even though it might be decades before you will be compelled to seek treatment. In the meantime it will progressively require adaptation in what you can do with your hands, depending on what you do and what fingers are eventually affected, if any. Obviously, the condition might already be presenting some concern while rock climbing, but pressure sensitivity and pain related to early contracture (nodule) may subside as your adjacent tissues get used to it.

For future reference:
Dr. Kline's Dupuytren's Center - Ontario, OR
Walt's Dupuytren's Contracture/Medical Site
Dr. Eaton's Hand Center - Jupiter, FLA

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#328479 - 07/29/06 06:43 PM Re: Lump in the palm of the hand.
layton Offline
sprayer

Registered: 11/27/00
Posts: 7420
TRs: 39 Photos: 811
Loc: Stony Brook, NY
extracorporeal shock wave therapy (finally remembered the name)

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