What is Dupuytren’s contracture?

Dupuytren’s contracture (Dupuytren’s disease) causes one or more fingers to bend inwards towards the palm of the hand. It can affect one or both hands and it sometimes affects the thumbs. Though the disease usually affects one finger most vigorously, the resulting restriction can limit the flexibility of neighbouring fingers and larger areas of the hand. Men are reported to be far more likely to have the disease than women.

Cause of Dupuytren’s

The fascia in the palm thickens with deposits of collagen which attach to the tendons and become sensitive to touch. Over time the deposits (or nodules) connect and form chords of solid tissue, which cause a contraction or shortening of the tendons in the palm. Between 5% and 25% of Dupuytren’s sufferers will also have Ledderhose disease – the relative disease of the feet, which causes a contraction in the arc of the foot.

Usually it occurs in men over 50 and women over 60. It’s a genetic condition and it’s more common in people of North European descent – apparently originating with the Vikings. Collette thinks that my Viking ancestors got it from rowing too much.

Effects of Dupuytren’s

Dupuytren’s is supposed to be a disease that affects just the hands and the fingers, however, I can tell you that it also affects my wrists, my forearms and less directly, my upper arms. The restriction of movement in my hands has a knock-on effect to the range of movement and strength throughout the rest of my limb. It also affects my fitness when I’m reluctant towards activities such as cycling, tennis, yoga, press-ups or lifting because of the associated pain. If I have done a lot of press-ups one day, my hands are likely to be painful the next. Playing with a basketball is a nightmare, which is a shame as I thought I may have had a USP there with my height. Psychologically, it’s a constant reminder of my ageing, my deterioration and ultimately my mortality, which can be challenging. However, on the flip side, it’s also a constant reminder of the need to look after myself and do what I can to work with what I have.

All of the advice around Dupuytren’s suggests that over time it won’t get any better. That’s not to say that my hand will definitely curl in, like my grandad’s did, like my dad’s has and like my brother’s has. It may be possible that mine may stay as it is now for the rest of my life.  I don’t feel that over the last 12 months it has gotten any worse. Maybe there’s something I’m doing – or not doing – now, that is making a difference? There may be a clue in the next paragraph.

Dupuytren’s and glucosamine chondroitin

There is a link between the onset and development of Dupuytren’s contracture and the consumption of glucosamine chondroitin. After knee surgeries for cartilage issues from football, I was advised to take glucosamine chondroitin to assist in my recovery. Glucosamine chondroitin helps to build up the collagen in the joints where there has been damage. This will have been around 12 years ago and certainly coincides with the onset of my Dupuytren’s. This may be a coincidence but it’s interesting to see that there is a recognised link and it’s good to be aware of these things.  I’d certainly be conscious of taking the supplement again.

On the yoga mat

Every time I go to yoga I spend a lot of time trying to open up my hands. It can be painful when a class starts with strong poses that require the hand to be flat to the mat, especially if I immediately start asking my hands to perform before they’ve been carefully, slowly and painfully eased open. Dropping into cobra with all of my upper body weight and my palms at 90 degrees to my forearms is excruciating for my palms and very tight in my wrists if I’ve not been warmed up.

When I place my hands flat to the mat I feel a tightness and sharp pain in the palm of my hands that centres on the thick nodule. The cooler and less mobilised my hands, the sharper the pain. I also feel a weakness in my wrist and a tightness, tingling and a lack of strength in my forearms. While most yogis have quite flexible wrists that can bend backwards quite significantly and easily to at least 90 degrees, mine are less elastic and struggle from 40 degrees onwards.

The tightness in my palms and forearms also seems to restrict non-weightbearing straight arm poses such as chair pose and warrior one. I can feel the tension from my hands down my forearms, my upper arm and even to my neck when I’m attempting to extend into space. The tension seems to weaken that fully-extended arm integrity you seek in the pose – it seems like a fight to fully extend. When it comes to weight bearing poses such as down-dog the same can be said, although the ability to press weight against the floor through the arms seems to work against the contraction and actually offer a stretch through the forearm. Hand stand offers a more demanding forearm stretch still but full body weight acts to bend the wrists back. Binds are made more difficult and so too is joining my hands behind my back for poses like humble warrior and bridge.

I’m not at a stage where I’m using props yet. Maybe some day I will need to. Maybe I won’t. There are some good pieces of advice for props with photos and diagrams in this discussion at Yoga For Healthy Aging Magazine (it’s an American spelling).

Poorly researched condition

There is little research around the condition. It tends to affect an older generation and it’s not life threatening so it seems not a great deal of importance has been placed on the prevention and treatment. Research suggests it may be linked to diabetes, epilepsy, alcohol consumption and smoking. Only recently have life expectancies reached such that the disease will effect people for a great period of their life. Not much is known about Dupuytren’s and there’s not a lot of knowledge regarding prevention and treatment.

What the doctors say

A UK NHS Doctor I visited for my Dupuytren’s said the NHS in the UK will do nothing until the finger is bent inward to a minimum of 30 degrees. He also advised me that manual labour, heavy gripping and repetitive actions will aggravate the condition and my sense and feelings around it corroborate this. After I’ve been landscape gardening, playing tennis or working out at the gym with lateral pull-downs, shoulder lifts or chest presses I get an increase in pain in my palms caused by the gripping actions, the frictions and the pressure of my palm to the bar. I’m lucky that I don’t have to do heavy lifting or use hand-tools for my work.

Manual labour seems to make it worse

My brother on the other hand (for want of a better phrase), has a manual job using hand-tools. He has suffered a lot more than I have with the condition. His little finger had bent down to a useless, obstructive and debilitating 60 degrees. He has recently had his first Regional Palmar Fasciectomy which is an open hand surgery to shave off the connected deposits on the tendons before opening the hand out and putting it in a splint to set back straight. I say first surgery because Dupuytren’s in most cases is likely to continue working on the tendons and he’ll most likely need op after op as long as he still needs to use his hand properly. After surgery, the hand is set back straight but the flexibility is still not good in the opposite direction and the scarring is not tidy at all.

Smoking and drinking with Dupuytren’s

The NHS website say’s that stopping smoking will reduce the risk of Dupuytren’s. Personally speaking, my hands feel tighter after a night out when I’ve smoked or been drinking. Actually, it seems that alcohol has a greater tightening effect and seems to increase the pain more than anything. I find that when I’m drink-free and well hydrated my hands feel less painful and more flexible.

Advice on stretching excecises from the doctor

When I asked my doctor about stretching exercises to combat Dupuytren’s he was very non-committal in his response. He couldn’t say whether stretching my fingers back would be a positive thing to increase flexibility or whether it may actually cause minor tears in the fascia which would then rush to repair themselves with more deposits of collagen. Stretching, particularly over- stretching, may actually cause a strengthening of the collagen nodule. But ultimately, there does not appear to be any decent research as to whether or not stretching is beneficial or counterproductive.

What other sufferers say

Responses from sufferers on online forums such as Dupuytren Online report various personal and anecdotal experiences as the best real evidence to support sufferers. Some say their doctors advise against stretching while some say their doctor demanded stretching as part of the recovery and prevention program. Some say stretching has been beneficial while some say stretching has caused a worsening of their contractures. Some say that they can’t be sure either way.

Personally, I feel that stretching to my comfortable limit offers some relief. I do this every day and hold each finger back on my hand for at least 30 seconds. Over-stretching, I find to be counterproductive as this can cause a lot of pain and the pain prevents me from stretching in the next days. Mindful stretching seems to work for me.

Massage

One thing I have found great relief through is arm massage – especially forearm massage. It relieves my arms and my nervous system. It assists with blood flow and a relaxation of my forearm muscles, which in turn seems to release tension in my wrist and palm. Massage to my upper arms also seems to cause a knock-on relaxation to my lower arms and this again increases the over all flexibility of my arms, wrists and hands.

Taking massage further, I received a very deep myofascial release massage where the masseur went deep into my neck with the insistence that massage in the neck will similarly benefit my arms and therefore my hands. The massage was uncomfortable but it did seem to have a positive effect on the way my arms felt for up to a week afterwards.

So does yoga help Dupuytren’s contracture?

The advice on stretching from doctors is poorly researched, inconsistent and confusing at best – but yoga is far more than stretching. Here are five ways that yoga has helped with my DC.

1. Initial Awareness

Placing my hand flat on the mat makes me aware of my disease. That intentional, conscious placement of my palms at right angles to the floor brings me in to my body. The practice of yoga has brought DC to my mind and caused me to consider it. What is it? How does it feel? What do I need to know about it? How can I provide nourishment to this issue or what can I do to help?

2. Deeper Understanding

Through yoga I have developed a body awareness that gives me a strong attunement with my condition. I am in a better position to be able to evaluate how my palms, fingers, wrists, tendons, forearms, joints and upper arms feel. I am sensitive to what works, what doesn’t work and what my response to certain stimulus is. Postures are creative ways for me to examine my body and I would not have the same deeper awareness of how my body is responding without varied asana. It’s not just awareness about my hands either – through yoga I am better equipped to preserve my knees and look after my other parts of my body that have suffered trauma.

3. Regular Focus

Regular attention to the area of concern means I can trace how my hands feel day to day. If I am in the yoga room later in the afternoon, I am more likely to open my fingers and prepare or warm my hands for a practice through the morning. Without yoga, I can spend days not thinking about my hands and when I come to use them for a task they are tight, sore, curled and cold and take a long time to soothe and become more flexible.

4. Massage

Through a connection to the healing and body-aware community, I have had the opportunity to witness first-hand and appreciate the value of massage. If you’re suffering from Dupuytren’s or any other form of restrictive physical ailment then massage can be a major benefit.  Without a link to the yoga community, I doubt whether I would have such an understanding and commitment to massage which has been so beneficial to me.

5. Reduced Smoking and Alcohol Consumption

2018 is an alcohol free year for me. The principles of yoga go hand in hand with consciousness and clarity.  Would I be going drink free in 2018 if it wasn’t for yoga? I’m not sure I would. With the associations between DC and alcohol consumption and/or liver disease, surely I can only be doing myself a good thing for the long term of my condition.

I’d urge you to share any good resources, experiences or advice that you might be able to offer in relation to the condition.

Thanks for reading
Pete

---

Other reading:

For more information about Dupuytren’s contracture visit: www.thisisdupuytrens.com

Practical Tips for Dealing with Dupuytren’s from the Dupuytren’s Society. 

Former professional cricketer and TV pundit Jonathan Agnew on how his Viking ancestry nearly cost him his hands.