Duputyrens Contracture

Why Can’t I Straighten My Finger ?

Duputyrens Contracture is often called the Viking disease as its very much related to North European heritage. Perhaps the incessant rowing over the hazardous North Sea and then clutching those heavy swords which they used with such effectiveness to diplomatically show the early residents of York and the North what the Vikings could do for them.

What Happens to my Finger in Duputyrens?

Amongst the many gifts from the Vikings was this contracture which happens particularly to people with a bit of Viking in them..it happens over time especially in those aged 50 or over – What doesn’t? . The first symptoms may be the inability of putting your hand in a pocket as the outermost fingers start to contract. This is followed by usually the outermost fingers starting to flex over, putting on gloves proves tricky and handshaking can prove awkward (but in these days of corona virus may be seen as an advantage.)

Duputyrens Contracture

So What Happens in Duputyrens?

Overtime a sufferer may feel a thickening of the skin particularly over the palm near the last two fingers, the skin may pit a bit as the tendon pulls on skin and eventually a hard fibrous nodule is felt. When this becomes severe the ring or little finger may buckle over and lead to tears in the skin. Thankfully the thumb is never affected in this condition as this would lead to far more disablement. Indeed the history of these Isles would be different as the poor old Vikings’ swords would have dropped out of their hands and have had to return to Sweden as laughing stocks.

Causes of Duputyrens

Nobody knows. That’t the problem apart from the heritage. This condition certainly runs in families and there does seem to be a link to people who are diabetic. Of course the fun things in life like alcohol and tobacco seem to be heavily linked as well, and certainly if you have blond hair , wearing a helmet with horns, and finding the grip lessening when you hold a sword now would be the right time to give up the fags and alcohol.

Complications of Duputyrens

One thing for sure you’re not going to die of this condition which should be a relief to many. However the problem lies that it can cause varying degrees of disablement for example writing / holding a pen can become impossible. You can imagine life if you’re a keyboard warrior (the modern equivalent of working with your sword). Your hand would never be able to tackle such a modernity. Simple things like getting things from you pocket become problematic.

Treatment Possibilities for your contracted hand

Certainly in the initial stages stretching your fingers and Osteopathic Manipulation may well help symptomatically, by breaking down some of the hard chords however this may be a temporary event. Studies have shown that Acupuncture or needling around the tendon can certainly help alleviate pain and some studies suggest that it may provide benefit for a period. So if it has started it is certainly worth having some treatment to try and help alleviate this problem.

If your fingers are curled over and is now totally inflexible then there are two choices:

  1. The first is a drug called Xiaflex, (but recently having spoken to a hand consultant who told me this is very difficult to obtain on the NHS now due to cositng (surprise surprise!), however if this is obtainable by whatever means then this substance is injected around the fibrous part of the tendon and after a few days the fingers are manipulated and you may feel a painless “pop” as the finger straightens. Duputyrens can return of course and the advantage is this treatment can be repeated.
  2. Surgery: The final resort if nothing else helps, this can be curative , but after such surgery it takes a few weeks to regain full use and of course the main disadvantage of surgery is it is surgery.

Finally if you think you may have a problem with your fingers or this condition might be starting give me a call as its fairly easy to diagnose and some treatment can be initiated to help bring back some function.

The Office and How to Survive it from a Sitting Point of View

The office whether we like it or not is the place where most of us will while away a third of our lives whilst employed in an office.

Questions are often asked as to how sitting might help mitigate the worst excesses of sitting all day and whether buying highly expensive seating from bespoke shops advertising enhanced seating experiences may help reduce the potential problems that extended periods of seating may confer to the sitter.

In a series of a few articles I aim to take you on a seated journey to explore the anatomy of sitting and what it does to you, (not a pleasant journey).

Should you manage to sit comfortably at the end of the article(s), not only will you be healthier, and in less pain  but you may also have saved yourself a lot of hard earned money by buying a chair that is both comfortable and reasonably priced.

My Back Hurts

Why Sitting too Much in an Office is Bad

So let’s start with the cheerful stuff first:

  1. Sitting too long hurts the heart in many studies including one done on bus conductors (when we had them) and drivers.  The drivers had twice the frequency of heart disease as those like the conductors who walked about.
  2. You are more prone to diabetes. It is not known exactly why, but the body whilst sitting seems to change its way it reacts to insulin the hormone that regulates your sugar level.
  3. You are more prone to DVT (Deep vein thrombosis), which in essence can kill you. The mechanism here is that your leg is flexed for prolonged periods and a clot can develop and travel towards your vital organs e.g. brain or heart.
  4. In a similar vein it can also cause varicose veins, again the prolonged sitting leads to increased pressure in the veins and if the valves which help contain the venous blood from flowing back stop working efficiently varicosities ensue.
  5. Osteoporosis is an added risk, from prolonged sitting bones aren’t getting forces through them which allow them to strengthen, which over time leads to a weakening of bone structure and makes people more prone to fractures.
  6. Sitting leads to increased disc pressure which increases the likelihood of disc problems such as herniations and prolapses. (More of this later)
  7. If I haven’t depressed you just yet, and as I get into the swing of warnings there is also the increase risk of cancer of the colon, endometrial and lung cancer.
  8. The final nail in the coffin is that sitting too long can shorten your life.

Now my mission is to very gently cheer you up.

Before this though let’s just debunk some of the more common perceptions of what the overall problem with “research” into correct seating is:

Firstly, when sitting people often have difficulty in telling which chair is the more comfortable whilst chairs have been graded into a hierarchy of ergonomic capabilities. Sitting in different chairs becomes indistinguishable because differences are difficult to perceive.

All spinal joints are attached by tendons and ligaments and via a complex of nerves via what is called a proprioceptive feedback (Cells in and around your joints convey back to the brain exactly where you are and at what angles which in turn relaxes and tenses different muscles to make you stable and not topple over.).

Joints are relatively insensitive to small angular changes as a result the spine does not recognize so easily small changes in posture.

As humans though we do perceive comfort. When were not comfortable most of us are not happy.  We therefore will always move the body into a position of maximum comfort.

In the end we it is comfort more than anything else which must drive our decision.

On this cliff-hanger I will add on this article next week to conclude the various options and what can be done both to extend your lives and help you sit more comfortably.

If you can’t wait for the next episode you can contact me anytime and although I won’t be able to give the plot away completely, I will ensure a peaceful week of sitting.

Shoulder Instability

Shoulder Instability

When Shoulder Instability was first Recognised:

Shoulder instability has not been new , and has been recognised over 3000 years ago on Papyrus in Egypt. Hippocrates used the old fashioned technique of placing a heel in the axilla of the unfortunate injured person and applied traction and with various degrees of success helped to “put the shoulder back in the right place. 

Dynamic Anatomy of Shoulder Instability

There are a group of Static stabilisers including:

The Dynamic Stablisers include:

  1. Bony
  2. Labrum
  3. Glenohumeral Ligaments
  4. Coracohumeral Ligaments
  5. Capsule
  6. Negative pressure (which helps “suck in arm to shoulder”.
  1. The rotator cuff
  2. Biceps
  3. Scapula stabilisers.
  4. Proprioreceptors

Anatomy of Instability

Instability happens when one of the above structures goes wrong eg the labrum a soft tissue lining that cloaks the joint may weaken, as it also is the anchor for ligaments.

There is good news as when we age this shoulder bone stiffens and becomes stronger reducing the propensity to disclocation.

The ligaments above the joint (the superior glenohumeral ligaments act as a restraint fo inferior/ posterior translation

The middle gleno humeral ligaments act as a restraint for inferior translation and also limits external rotation.

Testing the Shoulder

For any shoulder issue a general range of motion is done to see how far the shoulder will move, along with seeing how strong all the particular strengths and range of movements are: (external rotation, internal rotation, flexion and extension).

A very simple test is to just see how far down you can pull the shoulder instablility shows if the joint can be pulled down and show a dimple in the shoulder. This is called the sulcus sign.

The patients overall laxity must also be assessed. Generally as an overall test for laxity the mobility  of fingers, thumbs, elbows, knees and palms to ground is assessed.  A score of above 6 indicates hyper-mobility. This is often found in conditions such as Marfans and Ehler’s – Danlos syndromes.

The other tests that are done are X Ray , MRI arthrogram, and CT arthrogram.

Types of Instability

 Shoulder instability leading to anterior dislocation is at 90% the most common, which affect 2% of the population, around 90% of these occur under the age of 20, 14% recur after the age of 40.

Posterior dislocation comprise only 2 -5% of shoulder dislocations in such cases patients are unable to externally rotate their arm.

 Surgery For Recurrent Dislocations

 If a shoulder dislocates too often or recurs then surgery should be considered. This is particularly the case when there is structural pathology and when this occurs ligaments can be  tightened , and any looseness of the joint capsule repaired.

What Can Be Done Before Dislocation?

If a shoulder shows signs of instabilty there are plenty of shoulder strengthening exercises that can be done to address this issue.

Osteopathy and Acupuncture

Are very useful tools that can help both help ensure better stability, and is helpful in the post surgical rehabilitation where there might be residual stiffness and awkwardness in movement.