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Any Vikings in the closet?
The Vikings were quite some race of people. For many people today they are
purported to have been traders, but actually they were raiders as well. Their
longboats carried more than just randy oarsmen. They carried a remarkable
genetic disease producing contracture of the fingers on either hand, and which
was later called Dupuytren’s Contracture after Baron Guillaume Dupuytren, who
was once Napoleon’s surgeon.
It is a relatively common condition, with a global prevalence of 3-6 percent
with the highest percentage being in Scandinavian countries. Countries that have
seen a high level of immigration from Northern Europe also see a notably higher
rate of occurrence. (This does not cover today’s “boat people” who do not come
from Scandinavia!)
Dupuytren’s contracture generally affects the fourth and fifth fingers of the
hands and slowly flexes the fingers towards the palm of the hand. Eventually the
fingers cannot be straightened out and the sufferer cannot put his hand in his
pocket, without catching the finger(s) and it also becomes difficult to shake
hands, as the flexed fingers make it difficult to open the hand. The amount of
flexure is stated in degrees - up to 60 degrees covers mild to moderate cases,
whilst more than 60 degrees is considered severe contracture.
It is considered to be an inherited, genetic disorder. One study examined 832
relatives of 50 people with Dupuytren’s contracture and found that 68 percent of
the relatives were affected by the condition. Because of this, it is not a
condition that is accepted by insurance companies in many countries. Males
outweigh females in the ratio of at least 3:1 and the vast majority of cases are
also older than 50 years. The peak incidence is around 60-70 years in women and
50 years in men. If you have this condition, you shared it with Ronald Reagan
and Maggie Thatcher, both of whom also developed Alzheimer’s disease, but
there’s no connection between it and Dupuytrens.
In common with many people whose forebears came from the UK, I too have the
Viking disease, given to me by a Viking longboat man on one of his R&P (rape and
pillage) visits to Scotland over one thousand years ago. He did not leave his
name. And in keeping with the genetic component, my mother had the condition as
well. Thanks Mum!
The usual treatment to correct this condition is surgery, but requires the skill
of a specialist in hand surgery. It is also not an easy procedure, as the
thickened and contracted tissues (called the aponeurosis) in the palm of the
hand have to be dissected out from the nerves and arteries which can be caught
up in the thickened tissue. Not only is surgery difficult, but the recurrence is
also very high, with recurrence rate figures estimated to be in the range of 20
- 40 percent after five years.
However, there is another surgical technique, known as Needle Aponeurotomy (NA),
which does not call for surgical dissection, but is carried out under local
anesthesia and involves partially cutting the thickened tissue with the side of
a needle. Following this, forced extension of the affected fingers results in
the snapping of the aponeurosis, allowing the finger(s) to straighten out once
more.
NA procedures are not without problems either, but the incidence of side effects
appears to be less than surgery. The drawback is the recurrence rate, which
seems to be around 50 percent after a few years, but on the plus side, NA can be
repeated. NA is also not a common procedure, with many hand surgeons preferring
to continue with the ‘tried and true’ surgical techniques.
Now, back to my own condition. I discussed this with my hospital’s hand surgeon
Dr. Suradej and between us agreed to give NA a trial. That was almost four years
ago, and my deformity immediately after the NA procedure was then reduced to
only 10 degrees. We have been watching it carefully. At this stage there is a
slight increase in the deformity, but none of the aching pain I had before. I
estimate the deformity is now about 15 degrees.
So, if you have the ‘Viking disease’, it could be worth a consultation.
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