Typing and Dupuytren Disease

Problems with keyboard use are a common complaint with Dupuytren disease. A recent Dupuytren Research Group survey gives insight into the specifics based on the responses of 383 survey participants with Dupuytren disease.

It’s a common problem. Two-thirds of study participants reported Dupuytren-related difficulties with keyboard use.

Over half reported that they typed more slowly and one third described the need to take breaks from typing more frequently because of Dupuytren effects.

It’s not just bent fingers. Dupuytren without contracture was clearly a problem. What are the effects of Dupuytren with vs without contracture, which hand is involved, or one vs both hand involvement? Let’s break it down.

People with Dupuytren but no contracture. Typing problems were common in people with Dupuytren disease but no contracture. One-third of those with only one hand involved reported problems typing. Involvement of both hands was more troublesome, but not twice as much. One possible explanation is that people with visible Dupuytren in only one hand also have disease active but not visible in the “normal” hand. This would go along with prior observations that four of five people have Dupuytren in one hand when first diagnosed, but eventually, four of five people with Dupuytren develop the disease in both hands. Dupuytren disease affects hand use well before any contracture develops.

People with only one hand affected by Dupuytren. For those with no contracture, one third reported Dupuytren-related difficulty typing. Over two-thirds of those with contracture reported Dupuytren-related keyboard problems. Contracture greatly increases Dupuytren-related hand disability.

People with both hands affected by Dupuytren. If both hands had Dupuytren disease, the degree of Dupuytren-related typing difficulties increased with contracture. The difference in the effect of contractures involving one vs two hands may reflect the fact that there’s not much remaining margin to be worse than those with contractures of one hand.

Wrong keys. Many reported that their bent fingers hit keys even when they weren’t typing with that finger. What was the most common complaint? Hitting the wrong key – hitting a different key than intended. For the group reporting Dupuytren-related typing problems, over nine out of ten reported hitting unintended keys on the keyboard. Every key on the keyboard was reported by at least one person to be a wrong key problem for them. A common complaint was difficulty reaching the “upper keys” on the keyboard.

The most common wrong key combinations are shown here. Arrows point from the intended key to the actual key typed. Dark red arrows show the most common combinations.

Ring (yellow) and small (green) touch type positions were responsible for the most common wrong key substitutions.

Blue arrows show the overall trend. These follow the overall trend of Dupuytren contracture, bending the ring and small fingers down and preventing fingers from spreading apart. 

It’s more than just typing. While interesting, this misses the big picture, which is the day to day disability caused by Dupuytren disease. Here are just a few of the comments people volunteered when asked to describe what wrong key patterns they had.

My ring finger on both hands took over for pinkies but slowed me down. This worked before having both bent pinkies amputated.
All keys that my left little finger would normally hit. It is bent 90 degrees and is almost useless when typing.
Cannot reach any keys with my bent pinkies.
Unable to use my little finger on right hand due to fusion
I have 3 usable fingers on my left hand and 2 usable fingers on right hand.
Almost all the keys are problems at one time or another especially the top row. I also must use a “full” keyboard. Laptop is too small and virtual keyboards (cellphone or tablet) are impossible.
I have to just peck with my other fingers now. I used to type 65 wpm with no problem.
I have to “hunt and pick” any key that requires me to use my pinky. I used to be an excellent typist as it is a main part of my job.
I can only type with 2 fingers on my right hand and my thumb.
My thumbs keep hitting the space key and my little fingers are almost useless.
My ring finger does not lift up so it’s not used much anymore to type.
No particular key, just any of them, ditto on playing the piano … virtually impossible.
The digit that I cannot fully straighten often hits keys unintentionally or I have to close up my last 2 digits to prevent this.
I was a musician but now can no longer play a keyboard because of deformed hands.
Too many errors, I now use right hand only.
Too many to list.
Cannot type anymore.

This can’t go on. There were many other poignant and heartbreaking responses to this survey. The keyboard is just the tip of the Dupuytren iceberg, one of the countless activities impaired by Dupuytren disease. Because of the Internet, typing is a routine part of daily life.  The dramatic impact of Dupuytren disease on keyboard use is yet another demonstration of the need to support research to cure Dupuytren disease. We have to do better in the treatment of Dupuytren disease. Your hands are your life.

Charles Eaton MD

[Oct 8 2017: post updated with new keyboard graphics and keyboard discussion]