Drummers Health - Dupuytrens Contracture
Drummer's Health - Dupuytrens Contracture
There’s been a certain amount of talk on the forum about carpal tunnel syndrome but I’m afraid there is another affliction sent to make life difficult for us drummers: Dupuytrens Contracture.
It’s named after Baron Guillaume Dupuytren the surgeon who first suggested an operation to correct the affliction.
Dupuytrens is evidently a common hand deformity which affects first the palm, then one or other of the fingers causing a claw. Evidently a band of fibrous tissue in the palm thickens and contracts and causes a nodule which becomes a cord which over time contracts and pulls the affected finger towards the palm. What this means is you can’t straighten the finger. The condition worsens and eventually the finger bends at the knuckle, first towards 45 degrees (which is not so alarming) and then beyond (which really is concerning). A 90 degree bend is bad because in my recent experience, even though it doesn’t interfere with drumming, tennis or golf (when it’s the little finger that’s affected it curls nicely around the stick, racquet or club – though I struggled to get a ski glove on) chances are it’s not going to get any better. (I read that Margaret Thatcher had suffered from the same affliction and had her finger sorted when she was in office and figured if it was good enough for the Iron Lady it was good enough for a wimp like me!)
It’s affectionately known as the Viking disease and there are whole communities up at the very top of Scotland, where the Vikings raped and pillaged, who suffer from it. My family didn’t come from quite that far up but at a funeral recently I sat with a few of my aunts and discovered there are more than half a dozen on my mother’s side of the family with bent-fingers. So it’s hereditary. Steve White told me his dad had it so he’s going to have to keep an eye on his own digits as time goes by and so will my own offspring. I was sitting down at a showbiz lunch with John Coughlin (original Status Quo drummer) and spotted he has one of the dreaded bent fingers too and he told me he’d already had it done once!
To make matters worse for us drummers, Dupuytrens Contracture is more common in people who perform repetitive tasks, or use vibrating tools.
My particular deformity began almost a couple of years ago and I watched with interest as my right little finger curled disdainfully until I became worried enough to do something about it. My local hospital had a specialist from Europe who I was referred to. For technical reasons he was interested to know I was a drummer and wanted to see exactly how the stick fitted into my hand and we talked about what could be done.
At the moment in the UK the medical profession are licensed for two or three different operations with differing degrees of success and, perhaps more importantly, different recovery times. Naturally I wanted to get back to rocking and rolling so planned it carefully and plumped for the procedure I’d recover from quickest called either Percutaneous Release, or Needle Aponeurectomy. This could take as little as two weeks to recuperate from and I was determined to do it in that time because while I had managed to clear some gigs out of the way there was one in 18 day’s time I was determined to make. (Actually I had carefully planned the operation around a few gigs I had in Portugal with Russ Ballard which had been unfortunately postponed after I had a date for my procedure. But I decided, carpe diem, I was going to go ahead.)
Technically there was quite a difference in two of the procedures: the complicated but statistically more foolproof one called Palmar Fascectomy, required a general anaesthetic and a certain amount of ‘cutting and shutting’ in the palm presumably to remove the collagen collected there, and eight weeks to get over it. Mine necessitated a local anaesthetic just below the finger and a ‘winkling’ out with a needle in the various sites to tear the collagen away from the tendon. I could vaguely see this without my glasses which were confiscated for safety reasons.
This is what I was waiting for at 8 o’clock in the morning.
[There are other procedures, one of which one is considerably cheaper and involves an injection of Xiapex into the afflicted area. Xiapex is an enzyme which dissolves the collagen which promotes scar tissue. 24 hours later the finger is pulled straight which happens once a month and is combined with finger and hand exercises. I was interested in this option which is less invasive, but the specialist told me he’d been to a seminar where they’d discussed the technique at length and there are at present few problems with it, although they’re not insurmountable. Radiotherapy was once an option too but never used in the UK where we’re evidently justifiably afraid of the possible carcinogenic effects.]
There was talk of doing something to my ring finger at the same time but decided against. Who knows, they might have the bugs out of the less invasive injection process if I need it again.
Like recording studios, the ward had no clock and since my watch was in my bag I suspect I sat there writing this for an hour or three while the work of the surgicentre went on around me. By this time I had my right hand marked up with a big arrow facing towards the fingers - I assumed this was to ensure they had it the right way up! I also had the number 5 written on my palm to advise which ‘little piggy’ was to be operated on. (It wasn’t really necessary this because you couldn’t miss the one in question – it was set at right-angles to my palm.)
Eventually it was my turn and I put on my DVT socks, my back fastening gown, a sticking plaster over my wedding ring and a ridiculous hairnet. They walked me into the operating theatre which as usual appeared to be freezing cold. Certainly I was shivering although not of course with fear!
I climbed onto the operating bed and they painted my hand liberally with mercurochrome before laying it palm upwards on a table to my right. The anaesthetist advised me there would be a ‘scratch’ as he plunged a hypodermic loaded with some sort of anaesthetic into the area of the palm below my finger. Once it went cold they were ready to prod around with their needle and wiggle out the collagen attached to my tendon. As they did this every now and again pressure was applied to my finger to open the knuckle up to where it should be. I was well aware what they were doing but to be honest couldn’t feel a thing.
By 12.45 I was bandaged up and with a foam-padded aluminium splint fitted to keep me straight, enjoying a cup of tea and a biscuit. My hand was still sedated as the nurse and physio told me what I needed to do with it once the effect wore off. They gave me loads of pain killers so I anxiously assumed there might just be a certain amount of pain involved. I was going to have the splint on for three days then remove it to allow me to stretch the finger out frequently. I’d only need the splint then at nights and one week after the procedure they promised they’d remove the original dressing.
I cannot tell a lie but there was pain for the first couple of days (although nothing like giving birth my wife reliably informs me) but on the first night if I could have safely doubled up the drug dosage I would have. But eventually the throbbing pain became bearable and I decided rather than get hooked I’d go cold turkey on the pain-killers.
I give my great nephew a drum lesson every Friday and can honestly report, no matter how ambitious you are, you can’t play drums with a splint on your little finger!
By the time I got back to the hospital a week after the operation, due to the amount of gardening I’d done over the weekend the original dressing was disgustingly filthy. But everybody was really pleased with my progress and looking at the small cuts on my finger I couldn’t fathom why it had hurt at all. After that, rather than exercise my finger at certain times I simply used it normally.
Once the original bandage was off I sat down at the drums to see what would happen and it was a little uncomfortable as the pad of the injured finger bounced on the stick. But not to worry I still had a week to go before the first gig and I figured I might be able to get around that by using my little finger less and instil more bounce from my ring finger.
As if by magic the gig rolled round and when I drove into the car-park I discovered it was in a tent. I was disconcerted because this always means you have to work harder to get the sound out of the drums but in the event, it turned out to be the best sounding tent I’ve ever played in! (I realise that’s not saying much but we have to be thankful for small mercies.) I was concerned as to how the little finger would react to being hammered for 90 minutes but I needn’t have worried. It held up well and apart from banging it on the tom holder trying to save a mic which toppled over, it didn’t hurt at all.
Bob Henrit 2011
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