Getting to grips with a Celtic hand
MY HEALTH EXPERIENCE:Dupuytren’s contracture can become a major irritation, writes JOHN MORAN
OVER THE years, some of you will have occasionally noticed a small protuberance or nodule beneath the skin on the palm of your hand. No pain is involved, so it is easy to forget all about it until the next idle moment when it again comes to your attention.
As time goes by you begin to notice that the nodule has been slowly increasing in size and length. Eventually it stretches from the heel of the palm to between your little and ring fingers in a cord that contracts and begins to bend the fingers. By now you will be concerned enough to bring the matter to the attention of your doctor.
In Mercer’s Medical Centre, not far from St Stephen’s Green, Dr Judith Kavanagh immediately recognises the condition. She asks if she can test out the diagnostic skills of a student doctor, who correctly guesses: “It’s Dupuytren’s?”
Dupuytren’s contracture is named after Baron Guillaume Dupuytren – “the Napoleon of surgery” – who first identified the disease in the early 19th century. It is found mostly among northern Europeans, which is why it has sometimes been called the “Viking disease”. It has also been dubbed the “Celtic hand”.
While the name may be little known, Dupuytren’s is not uncommon. Most at risk are: those whose family members have been affected, men over the age of 40, diabetics, smokers and heavy drinkers. Its characteristic nodules produce excess collagen – a protein that makes bones, tendons and skin – which forms a cord, congeals and pulls the fingers towards the palm.
As Dupuytren’s advances, it can become an increasing irritation in your daily life. Bent fingers can snag when you are trying to put your hand in your pocket. Wayward fingers can poke your eye when putting on glasses. Shaking hands can also be awkward because of the bent fingers. (Knew it, he’s a Freemason.) There is also the increasing difficulty of trying to type with two crabbed fingers.
Kavanagh suggests I see a consultant in Blackrock, Phil Grieve, an orthopaedic surgeon with a sub-speciality interest in hand and wrist surgery, whom she has heard deliver a lecture on the subject.
Cost is a key consideration. I discover from the VHI that the two of the three treatments for Dupuytrens carried out in Blackrock Hospital are covered under my Plan B, so I travel over to check it out.
Having taken a close look, Grieve applies the “table-top test” whereby the hand is placed palm down on a surface. If it can’t lie flat, surgery may be required – mine cannot because of the bent fingers.
Grieve then outlines the appropriate treatments: 1. Minor surgery using needles to break up the knots and cords causing the contracture; 2. Full surgery to remove the diseased tissue (palmar fasciectomy). 3. A new treatment involving the injection of a collagen serum.
We settle on option number two, which has been referred to as the gold standard in Dupuytren’s treatment.