I’m a Viking: Dupuytren’s Contracture

About a year ago, I noticed some weird things about my hands, and after doing some googling, I emailed Lo and said that I probably have cancer on my thumbnail, and that my right hand would be crippled soon.  I wasn’t completely serious, but they were some things I wanted to get checked out.

I have a dark grayish line that runs the length of my left thumbnail –which can be a sign of melanoma.  The fact that my dad had melanoma on his face, and I’ve had pre-cancerous spots removed in the past definitely made me want to get this looked at.  I actually thought this was the more likely of the two “issues”.

The crippled hand thing came about in the form of a lump on my right palm.  I noticed it while on maternity leave during one of my many hours on the couch nursing and holding a sleeping Jenson.  It was a painless lump under the skin that felt exactly like a pea.  It didn’t hurt to touch it, but it kind of grossed me out because it wasn’t supposed to be there.  The google search for this indicated Dupuytren’s Contracture, or Dupuytren’s Disease, which would eventually make my ring finger (and possibly pinky) curl in towards my palm, as the tissue forms a cord that contracts and pull the affected fingers in towards the palm.  I didn’t really fit the profile, as it typically affects men over age 50, with smoking, drinking, and diabetes to be additional risk factors, in addition to family history.  The only other risk factor, which I did fall within, is being of Northern European descent.

So I made an appointment to see my general doctor, because while I knew the thumbnail thing was probably a dermatology issue, I had no idea where the hand thing fell in terms of doctors.  Apparently Dupuytren’s isn’t under general medicine, because my doctor looked at both things for a minute and told me to go to a dermatologist.  He was pretty sure it wasn’t Dupuytren’s though…probably just a callus or a benign cyst under the skin, but since I needed to go for my thumbnail, they could take a look at that too.

The nurse practitioner and dermatologist both thought the line on my thumbnail was kind of an air pocket thing created from having crappy cuticles. I was instructed to stop cutting or picking at my cuticles (guilty) and use a thick protective hand moisturizer.  It’s still there, but truthfully I haven’t been good at following either instruction.  I really would have expected it to grow out by now though, so I’ll definitely mention it again at my yearly skin check.

The NP looked at my palm and pretty quickly diagnosed Dupuytren’s Contracture.  She started explaining it, but I made it easy on her and told her I had already read up on the issue.  We talked about when to seek treatments – basically when my finger starts to curl in and I can’t place my palm flat on a table.  She said it could be years before it got any worse, though during the 8 or so months from when I first noticed the lump and went to the Dr., a cord had already formed.  She said I could go to a hand specialist now, if I wanted to become a patient before I needed treatment, and so they could get a baseline, or I could just wait.  I mentioned how I didn’t seem to fit the risk factors in any way, other than the Northern European thing, but she said that she had a young female patient the previous week who she also diagnosed.  I did a little more research and there are two main treatment options: injections of some type of acid that dissolved the cord of tissue (without affecting other tissue and with little recovery), or surgery where they can cut the cord (with risks of scar tissue forming and nerve issues, plus a much longer recovery and physical therapy).

I decided to go to a hand specialist sooner than later, as I wanted to make sure I knew where to go once the contracture starts – plus I’m already a patient of a hand, wrist, elbow surgeon, Dr. Stutzman, from when my elbow tendon was a mess and I was contemplating surgery.  For my appointment, I didn’t even see my surgeon – just another Dr. or nurse practitioner or intern…I don’t remember her qualifications.  She confirmed that it is Dupuytren’s and said that Dr. Stutzman would say that it’s a sure sign that I have Viking blood, as it’s a disease that originated with the Vikings, and spread through the Northern European countries as they migrated (or conquered).  It is also known as Vikings disease.  She talked about when I needed to come back for treatment and a little more about the treatment.  They use the injections and have very high success with the treatment, though nothing ever cures it.  It’s possible that it will never contract any further.  She was surprised that I didn’t know of any family members with it because it runs pretty strong in families.  I asked ifanything else can “cause” it – such as hitting my hand repeatedly, or playing volleyball or anything.  She said no…it’s just something that happens, or doesn’t.  It is the hand that I regularly smack on the floor when I dive in volleyball (especially for pancakes [not the food]), but I guess that has nothing to do with it (luckily).  She said I may eventually need to avoid putting much pressure on my palm or extreme flexion of the wrist (like in yoga or pushups) if it becomes uncomfortable and my range of most starts to lessen as the cord tightens, but that nothing should make it worse.

At the next family gathering, I asked around, but no one else has any palm lumps.  My dad’s fingers are pretty janky, but that’s from years of working with his hands and playing basketball (and never seeking treatment for broken fingers).  My grandma’s fingers curl in, but she’s 87-ish with some arthritis, so that’s the reason for that – or at least I couldn’t feel any lumps or cords on her hands.  Maybe it comes from my dad’s side….he has very few distant relatives who are still alive, and almost none with whom we have contact, so I’ll never really know.  It’s not like it’s a big deal that I don’t know where it came from – just a curious thing that no one else seems to have dupuytrens.  I’d much rather have this than melanoma under my thumbnail, like I originally worried.

It’s still weird to touch the lump on my palm, but I’m less grossed out about it.  It’s also weird to know that someday my fingers will start to curl in and “cripple”, but I feel pretty good about the treatment process and outcome, and that there will probably be even better and longer-lasting treatment by the time I need it.