A pain in the …

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The ring finger does not straighten.

Kensington, Maryland, December 23, 2015 —  This is going to be short because I’m typing with one hand.  Apologies to my Facebook friends.  You already know this, but you’ll see it again because my blog automatically posts to Facebook and Twitter.

I won’t be involved in much outdoor activity for awhile and there’s a good reason.

I inherited a recessive gene that causes Dupeytren’s Contracture. This is sometimes called “trigger finger.” https://en.wikipedia.org/wiki/Dupuytren’s_contracture. Dupeytren’s is common to people of northern European heritage.

I like to say that the Vikings married their sisters back in the fiords, then spread the love while raiding and pillaging the British isles and the north coast of the continent.

Unfortunately I have a aggressive case and it exists in both hands. The disadvantage as a hiker, backpacker and trail maintainer is this:  I can’t get a glove or mitten on my right hand.  That could mean a quick trip to frostbite city in cold weather.  This condition specifically kept me from hiking the Long Trail this month with my friend Max and his dad.

Dupeytren’s (named by a pioneering French anatomist) can be treated in two ways.

The traditional approach is surgical where they slice away the collagen that grows around the affected tendons. The much newer alternative is to inject a solution that dissolves the culprit collagen.

I’ve previously had two surgeries on my right hand, and I had one injection procedure immediately before starting the winter portion of my AT thru hike..

This week I had another injection, this time into my right ring finger. The next day the doc straightened it out using a technique that I am certain came right out of the CIA’s torture handbook. Trust me.  You’d cough up your secrets!

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Novocaine is used both prior to the Xiaflex injection and subsequently when the orthopod unbends the affected finger.

The injection of bacteria-derived proteins (marketed as Xiaflex) is quick and done in the physician’s office. The procedure itself is more unpleasant than surgery – I mean they stick needles into the palm of your hand – albeit numbed with Novocaine, but even with the magic of numbness, it’s not nearly as fun as going to the dentist. 

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Post manipulation. The bruising gets more pronounced the second day.

The Xiaflex advantage is a blessedly quick recovery. I expect to return to the gym after two weeks. I should be able to run on Christmas Day.

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A brace is fashioned to help keep the fingers straight. Physical therapists work about every other day to return the finger as close to normal as possible. After a week, the brace is worn only at night – for four weeks.

Later in January I’ll have surgery to clean up the Dupeytren’s affecting my left thumb because I can barely open a large peanut butter jar.

The FDA has not approved Xiaflex for use on thumbs.  Fingers only.  Surgical recovery is a full six weeks. The PT is similar for either procedure.