I was climbing and suffered a similar injury in the palm of each hand beneath my ring fingers. The injury felt like needle pricks and left a lump beneath the skin in each palm and tightness in the area beneath the lumps extending toward my wrists. I searched the internet, and my injury appears to be either a lumbrical tear or Dupuytren’s. What do you think? — John McPhersonit
Dupuytren’s disease is the most likely diagnosis and, along with that, some Viking heritage. Do you have a striking jawline, and high cheekbones? Given the description of your injury—a small lump and concurrent tightness— there is little else that it could be.
A multitude of risk factors, from bad habits—alcoholism and smoking—to diseases such as epilepsy and diabetes, some autoimmune conditions, and a strong genetic and Nordic hereditary influence make Dupuytren’s disease the most common connective tissue disorder in Caucasians.
Dupuytren’s disease causes knots of tissue to form under the skin, such that a finger or fingers permanently contract, and is typically progressive and rarely resolves spontaneously. Though less common, simultaneous affliction in both hands such as you likely have does happen. Dupuytren’s may cause the affected finger to contract, and the degree of contracture and how the disease unfolds are impossible to forecast. Some people get a small contracture, and others get it to the point that the finger needs to be amputated just to get it out of the way!
As always, there are a bunch of shambolic treatments out there preying on the desperate and naive. The usual array of creams, supplements and gadgets are proffered over the web. None of them work anything more than your wallet.
You will intuitively want to stretch the finger, endeavoring to alleviate the mounting tension. Don’t. Studies suggest that stretching may actually aggravate and speed the contracture process.
Surgery, whereby the surgeon removes the diseased tissue and some extra, has been the go-to treatment for many decades. The rate of recurrence has many variables, such as which joint is affected and whether it has been surgically released in the past (there is a high rate of revision surgery). No one would argue, however, that the recurrence rate is somewhere between huge and massive, generally north of 50 percent.
There are less invasive techniques. Although the recurrence rate is similar, procedures like needle aponeurotomy are much cheaper, have fewer risks, have quicker recovery, and can be repeated at no extra anatomical cost should the disease reappear.
FINGER INJURY OR DUPUYTREN’S?
Although the palm is extremely complex, with many intrinsic muscles and tendons, climbing injuries affecting this area are relatively few. The primary difference between this disease and an injury around the base of the finger that might be confusing is how the pain started. Anything associated with an OMG moment is likely an acute injury and not Dupuytren’s disease. Assuming the pain starts slowly, chronic stress around the A1 pulley or the opening of the flexor sheath (known as tenovaginitis) are two possibilities, albeit they are less common than Dupuytren’s disease.
The defining difference is the presence of a nodule in the palm that is associated with reduced finger extension once the disease gets going. In its early stages, differentiating the disease from these options is more nuanced and requires a professional eye.