Dupuytren advice

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
petrichor
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Dupuytren advice

Post by petrichor » Sat Jan 20, 2018 5:09 pm

I'm starting to develop some little nodules in my left hand and of course am concerned about it. I can play fine, but I can also feel "something" in the hand - a tightness, and it can cause me to wonder if something I'm playing is hard because .. it is hard, or if I'm starting to experience some limitations.

I've been to a orthopedic hand doctor who basically said - "yep, we can do surgery" - THAT sounds scary..


I've read about some pianists who had injections, and are completely (?) back to normal.

Has anyone else had recent experience with these sorts of treatments?

thanks!

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prawnheed
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Re: Dupuytren advice

Post by prawnheed » Sat Jan 20, 2018 5:21 pm

This is not a medical forum. And even if it were, I'd ignore any advice you got from it.

If you want a second opinion, consult another doctor.

petrichor
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Re: Dupuytren advice

Post by petrichor » Sat Jan 20, 2018 5:42 pm

thank you for your response. I've seen other posts on Delcamp concerning Dupuytren's and was just wondering about other's experiences, not a diagnosis.

Is there a better forum I should be posting in?

thank you again.

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guitarrista
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Re: Dupuytren advice

Post by guitarrista » Sat Jan 20, 2018 5:49 pm

Did you ask him about percutaneous needle fasciotomy? Also "we can do surgery" is too vague - there are several different surgical procedures that are options. Also there are less invasive ones (that still break the skin) like the one I mentioned. And then the non-contact ones which are suspect in terms of having much of an effect.

BTW Petrichor is a great word - the smell in the air just after a summer rain, usually in an urban setting. :)
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JohnB
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Re: Dupuytren advice

Post by JohnB » Sat Jan 20, 2018 7:47 pm

I'll relate my experiences, for what they are worth. But first I must say the the nodules have never had any noticeable effect on my fingers - none at all. It sounds as though your Dupuytrens is in the very early stages.

I gradually developed Dupuytren's Contracture over some decades. It mainly affected the little finger on my right hand (which became curled inwards), but it started to affect the "a" finger as well. Eventually I decided I needed to do something about it.

First I had a referral to the orthopaedic team at a large teaching hospital. When I explained to them that I played a musical instrument they backed off and suggested I get a referral to another speciality.

I finally got a private referral to a well regarded specialist hand surgeon (Donald Sammut) who was also a plastic surgeon. Interestingly, he didn't stitch up the wound in my palm - he left it open and it healed without stitches. The reasoning was that it would have a better outcome than if it was stitched.

Immediately after the operation, everything was remarkably good. Some time later I began to have problems alternating im, though that might have been due to other causes. I stopped playing for 10-15 years and have only picked it up again relatively recently, with no "i/m" problems. The issues that developed in my right hand might well have been due to focal dystonia (a term I dislike) rather than the operation.

The after effects of the operation are an area in the palm and at the bottom of the little and the "a" finger that feels as though there is a thinish plaster stuck there (due to the inevitable scarring).

If you do decide on surgery I would make absolutely sure that the surgeon is an experienced, specialist hand surgeon NOT a general orthaedic surgeon (think hammers and saws).

HOWEVER, these days there are many other options available (instead of surgery) and I would most definitely pursue those first. Do as much research as you can - there is a lot of reliable information on the web (as long as you use reputable sources). It developed very slowly in my case, so if that is typical there is no immediate urgency.
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petrichor
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Re: Dupuytren advice

Post by petrichor » Sat Jan 20, 2018 9:25 pm

thank you both for your responses. I think I'm just starting out on this journey, and have been wondering if my playing days are numbered. I did ask to be referred to an orthopedic hand doctor who was familiar with musician's needs and was concerned and was taken aback when he said we could just opt for surgery right away. I am interested in finding a second opinion, but I don't think there are a lot of options where I live. I am very interested in the least invasive method possible, and percutaneous needle fasciotomy seems like the best bet. I have begun to research, but I wanted to start out here, since this is a group who knows how dupuytren's affects playing guitar. research on the internet can be a firehose of information, that's for sure.

I'm encouraged to know there may still be some playing left in me, and I'd be very interested in the what recovery and therapy would be for the needle treatment.

johnb: when you say "thinish plaster" I take that to mean you have a feeling of something foreign in your palm - I'm sorry to hear that, and wonder if it is an issue when playing.


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JohnB
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Re: Dupuytren advice

Post by JohnB » Sat Jan 20, 2018 10:29 pm

Petrichor, do you only have nodules in your palm or have some of your fingers started to curl inwards? if so, to what extent?

If you only have nodules but your fingers aren't affected I would probably just keep an eye on it for now. Incidentally, Donald Sammut remarked that if DC develops in my other hand and the fingers start to lean forwards - to periodically sit on the hand, face down, to slow the curling in. I have no idea whether that is sensible or not (but he is highly regarded).

By the way, I believe that in the UK Dupuytrens surgery can either come under orthopaedic or plastic surgery. Anyway, the hand is very complex and an experienced specialist hand surgeon is a very, very good idea.

You asked about the feeling of having a thin-ish plaster on my palm. It doesn't seem to affect my movement - it is more of an awareness.

You might be interested in this summary of treatment options on the UK National Health Service website. The NHS isn't a commercial body so I hope I am not contravening the forum rules. https://www.nhs.uk/conditions/dupuytren ... treatment/
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petrichor
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Re: Dupuytren advice

Post by petrichor » Sat Jan 20, 2018 10:50 pm

thank you very very much.

Collagenase clostridium histolyticum sounds like the most inviting (well, the least intimidating)

I have nodules on my left palm - one on finger 2 (middle finger) sort of on the other side of the knuckle, and 2 smaller ones more towards the middle of my palm on finger 3. As of now it Is probably similar to your situation - an "awareness", but sometimes feels like a tightness in my palm, sometimes a bit like having a cramp. no curling as of yet, but these become more present over the last year or so.

It sounds like I can wait until there is some curling starting in my left hand fingers. It seems like a waiting game, and Ideally, I'd like to minimize my down time if possible. I'm just wondering if there's an optimal time for treatment, and if there are mitigating exercises, or other delaying tactics. I've wondered if things like heating pads, or topical ointments or lotions (Capsaicin or something similar) have any effect. In the same vein - I've wondered if doing strenuous technique exercises where the left hand is stretched is good... or bad. then there's diet and supplements and all those thoughts too...

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Re: Dupuytren advice

Post by Intune » Sat Jan 20, 2018 11:51 pm

Several years ago my wife had medicine injected into her right-hand pinky for Dupuytren's Contracture, and within a day or two, at a follow-up visit, the hand specialist abruptly "snapped" the pinky straight from its curled position. The procedure didn't hurt, she reported. For a few months afterward she wore a splint at night to make sure the finger remained uncurled. While it's not completely straight today, the finger is vastly improved and functions normally. To look at it, you wouldn't know anything had been wrong. Some Dupuytren patients might need more serious treatment than that -- i.e., surgery -- but my wife was one of the lucky ones. The shot may be a good place for you to start, providing your hand specialist is familiar with the procedure and agrees. Good luck.
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DerekB
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Re: Dupuytren advice

Post by DerekB » Sun Jan 21, 2018 4:32 pm

I have Dupuytren's in both hands. It started in my right hand about eleven years ago and subsequently developed in my left hand. It is a long time since I have had any discomfort from it and it doesn't cause my fingers to curl inwards. The GP who I consulted about it told me that it is best to avoid surgery as it usually makes it worse. I have never done anything about it and it has not prevented me passing a number of Trinity exams with good results.

It is a condition which varies in severity and can give no trouble for very long periods. In your case only time will tell but I wouldn't panic. My advice is to wait and see.
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Rick Beauregard
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Re: Dupuytren advice

Post by Rick Beauregard » Sun Jan 21, 2018 6:27 pm

So far I’ve tried ice, moist heat (helps short term), voltaren gel (no help), stretching, soft splints, massage, ultrasonic massage, ibuprofen (somewhat helpful), Boswellya, CoQ10, Tumeric, gelatin, rest.

My right m finger triggers/snaps at extreme coil inward, but doesn’t impact my playing except for stiffness and pain after playing or in the morning. I have some stiffness and nodules on the left m finger as well, which tells me it is age/genetics/complications of type II diabetes, or drug (statin) side effects as opposed to repetitive injury, since each hand has a different type of stress on the guitar.

Bottom line is: I won’t opt for surgery unless it prevents my playing without more severe pain. I may try the cortisone shots first, which reportedly can work if sometimes requiring multiple treatments but often not permanent. I have not seen a specialist yet. These remedies (with the exception of non pharmaceutical/natural-pathic ones) were recommended by my doctor. I also think if I could get off the low dose of statins I am taking, it might reverse this and other inflammation related symptoms, from what I’ve read about side effects.
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petrichor
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Re: Dupuytren advice

Post by petrichor » Tue Jan 23, 2018 1:27 pm

Thank you again, everyone, for your advice and guidance!

henders
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Re: Dupuytren advice

Post by henders » Fri Feb 02, 2018 3:24 am

Best of luck and in musical solidarity.

GeertWil
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Re: Dupuytren advice

Post by GeertWil » Fri Feb 02, 2018 5:01 pm

In my case Dupuytren in my left hand has been diagnosed about 5 years ago. In my country I have to wait till my fingers stay fixed at 45° angle before the treatment is partially payed back by the insurance. This is not the case yet. On the other hand (sic) I believe that very regular stretching excercices help me control the symptons. I can still play guitar as before (i.e. not as good as I wanted to). The situation is stable. Mid 2017 I noticed the same symptons in my right hand.

petrichor
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Re: Dupuytren advice

Post by petrichor » Sun Feb 04, 2018 2:46 pm

Geertwill-

Could you describe the stretching exercises you do?

Thanks

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