Dupuytren contracture disease causes progressive thickening of palmar fascia to result in painful finger contractures and disability.
It affects the fourth and fifth fingers generally. Dupuytren contracture is a type of fibromatosis like plantar and penile fibromatosis.
The ring finger is involved with the fifth and then the middle finger. Males develop disease three times more often and with greater severity.
Stages of Dupuytren disease as follows:
Proliferative phase
Involutional phase
Residual phase
Male predominance linked to androgen receptor expression. Rheumatoid arthritis may prevent Dupuytren disease development.
Pain is linked to nerve fibres in fibrous tissue or local nerve compression. Myofibroblasts align along tension lines in the nodule’s phase.
The nodular tissue disappears and acellular tissue with thick bands of collagen remains.
Dupuytren’s contracture is named after French surgeon Guillaume Dupuytren in 1833. The palmar aponeurosis extends from the wrist, crosses the ligament, and splits into bands for digits.
Spiral and lateral cords displace the neurovascular bundle centrally, while a central cord usually encases and directs it to one finger side.
McFarlane explains spiral cord displacement increases neurovascular bundle vulnerability to injury during surgery.
Epidemiology
Dupuytren contracture affects 4-6% of Northern European descent individuals. Dupuytren disease is 4% prevalent in the U.S. due to immigration.
Northern Europe shows prevalence of 4 to 39% with 30% of men more than 60 years old. In 2004, Dupuytren disease incidence was 34.4 per 100,000 for British men aged 40-84.
Australia’s prevalence of 28% surpasses Spain’s 19% in men over 60 years. About 80% of those affected are male with onset typically in the fifth to sixth decade of life.
Anatomy
Pathophysiology
Investigators proposed hypotheses for Dupuytren disease pathogenesis. Localized ischemia leads to ATP conversion to hypoxanthine and xanthine dehydrogenase conversion to xanthine oxidase.
Free radicals lead to fibroblast growth and cytokines. Higher nerve growth factor levels promote fibroblast transformation to myofibroblasts.
LPA binding to myofibroblast receptors decreases cyclic AMP and increases intracellular calcium levels.
Excess type III collagen results from increased fibroblast density due to heightened stimulation, reduced apoptosis, and collagenase inhibitor imbalance.
Etiology
The causes of Dupuytren Contracture are:
Genetic Predisposition
Cellular & Molecular mechanisms
Environmental & lifestyle factors
Hormonal & metabolic factors
Genetics
Prognostic Factors
Morbidity from Dupuytren contracture mainly affects lifestyle, as MCP and PIP joint contractures disrupt daily activities.
Aggressive disease associations, but Dupuytren contracture has no mortality.
Retrospective review of 593,606 patients found 15,416 developed trigger finger post-diagnosis.
Collect details including chief complaint, history of present illness, and medical history to understand clinical history of patient.
Physical Examination
Range of Motion Assessment
Neurological & Vascular Examination
Inspection
Palmar skin changes
Palpation
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Typical symptoms are:
Painless nodule in the palm, gradual formation of fibrous cords, loss of extension at MCP and PIP joints over time.
Differential Diagnoses
Clavus
Epidermoid Cyst
Fibroma
Tendon nodule
Lipoma
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Dupuytren disease management includes various non-surgical and surgical options depending on disease severity, deformity, function limitations, and provider choice.
Contracture degree affects surgical outcomes in proximal but not metacarpophalangeal Dupuytren disease.
MCP joint groups had identical surgical success rates and contracture resolution.
PIP joint contractures over >300showed lower reduction index than groups 1 and 2.
Observation suits patients with painless Dupuytren disease and minimal contracture. Mild Dupuytren disease patients need follow-ups every 6-12 months for monitoring.
Heat and ultrasound stretching may benefit early Dupuytren contracture stages. Physical therapist may suggest custom splint or brace to stretch fingers more.
Occupational therapy enhances functionality through adaptive techniques.
Fasciectomy surgery allows joint extension with earlier intervention benefits.
A study suggests performing surgical fasciectomy for Dupuytren disease and carpal tunnel release simultaneously, as the complication rate remains largely unchanged.
Percutaneous needle fasciotomy is a minimally invasive office procedure under anaesthesia.
use-of-phases-in-managing-dupuytren-contracture
In the early phase, the focus is on observation and conservative management aspect of patient.
Pharmacologic therapy is effective in the treatment phase as it includes the use of enzymes and corticosteroids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the rheumatologist are scheduled to check the improvement of patients along with treatment response.
Dupuytren contracture disease causes progressive thickening of palmar fascia to result in painful finger contractures and disability.
It affects the fourth and fifth fingers generally. Dupuytren contracture is a type of fibromatosis like plantar and penile fibromatosis.
The ring finger is involved with the fifth and then the middle finger. Males develop disease three times more often and with greater severity.
Stages of Dupuytren disease as follows:
Proliferative phase
Involutional phase
Residual phase
Male predominance linked to androgen receptor expression. Rheumatoid arthritis may prevent Dupuytren disease development.
Pain is linked to nerve fibres in fibrous tissue or local nerve compression. Myofibroblasts align along tension lines in the nodule’s phase.
The nodular tissue disappears and acellular tissue with thick bands of collagen remains.
Dupuytren’s contracture is named after French surgeon Guillaume Dupuytren in 1833. The palmar aponeurosis extends from the wrist, crosses the ligament, and splits into bands for digits.
Spiral and lateral cords displace the neurovascular bundle centrally, while a central cord usually encases and directs it to one finger side.
McFarlane explains spiral cord displacement increases neurovascular bundle vulnerability to injury during surgery.
Dupuytren contracture affects 4-6% of Northern European descent individuals. Dupuytren disease is 4% prevalent in the U.S. due to immigration.
Northern Europe shows prevalence of 4 to 39% with 30% of men more than 60 years old. In 2004, Dupuytren disease incidence was 34.4 per 100,000 for British men aged 40-84.
Australia’s prevalence of 28% surpasses Spain’s 19% in men over 60 years. About 80% of those affected are male with onset typically in the fifth to sixth decade of life.
Investigators proposed hypotheses for Dupuytren disease pathogenesis. Localized ischemia leads to ATP conversion to hypoxanthine and xanthine dehydrogenase conversion to xanthine oxidase.
Free radicals lead to fibroblast growth and cytokines. Higher nerve growth factor levels promote fibroblast transformation to myofibroblasts.
LPA binding to myofibroblast receptors decreases cyclic AMP and increases intracellular calcium levels.
Excess type III collagen results from increased fibroblast density due to heightened stimulation, reduced apoptosis, and collagenase inhibitor imbalance.
The causes of Dupuytren Contracture are:
Genetic Predisposition
Cellular & Molecular mechanisms
Environmental & lifestyle factors
Hormonal & metabolic factors
Morbidity from Dupuytren contracture mainly affects lifestyle, as MCP and PIP joint contractures disrupt daily activities.
Aggressive disease associations, but Dupuytren contracture has no mortality.
Retrospective review of 593,606 patients found 15,416 developed trigger finger post-diagnosis.
Collect details including chief complaint, history of present illness, and medical history to understand clinical history of patient.
Range of Motion Assessment
Neurological & Vascular Examination
Inspection
Palmar skin changes
Palpation
Typical symptoms are:
Painless nodule in the palm, gradual formation of fibrous cords, loss of extension at MCP and PIP joints over time.
Clavus
Epidermoid Cyst
Fibroma
Tendon nodule
Lipoma
Dupuytren disease management includes various non-surgical and surgical options depending on disease severity, deformity, function limitations, and provider choice.
Contracture degree affects surgical outcomes in proximal but not metacarpophalangeal Dupuytren disease.
MCP joint groups had identical surgical success rates and contracture resolution.
PIP joint contractures over >300showed lower reduction index than groups 1 and 2.
Observation suits patients with painless Dupuytren disease and minimal contracture. Mild Dupuytren disease patients need follow-ups every 6-12 months for monitoring.
Heat and ultrasound stretching may benefit early Dupuytren contracture stages. Physical therapist may suggest custom splint or brace to stretch fingers more.
Occupational therapy enhances functionality through adaptive techniques.
Rheumatology
Use various tools with large grips/holding to reduce strain.
Increase use of adaptive gloves for smartphones/tablets while working.
Use lever-style door handles instead of round knobs for comfortable grip.
Use Jar and bottle openers to reduce load on fingers/hand.
Patient should learn and follow hand therapy exercises to improve flexibility and function.
Avoid smoking and excessive alcohol habits for long periods of time.
Proper awareness about Dupuytren Contracture should be provided and its related causes with management strategies.
Appointments with rheumatologist and preventing recurrence of disorder is an ongoing life-long effort.
Rheumatology
Collagenase Clostridium histolyticum:
It hydrolyzes collagen in native triple-helical conformation to cause lysis of collagen deposits.
Rheumatology
Triamcinolone:
It decreases inflammation to suppress migration of polymorphonuclear leukocytes.
Rheumatology
Fasciectomy surgery allows joint extension with earlier intervention benefits.
A study suggests performing surgical fasciectomy for Dupuytren disease and carpal tunnel release simultaneously, as the complication rate remains largely unchanged.
Percutaneous needle fasciotomy is a minimally invasive office procedure under anaesthesia.
Rheumatology
In the early phase, the focus is on observation and conservative management aspect of patient.
Pharmacologic therapy is effective in the treatment phase as it includes the use of enzymes and corticosteroids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the rheumatologist are scheduled to check the improvement of patients along with treatment response.
Dupuytren contracture disease causes progressive thickening of palmar fascia to result in painful finger contractures and disability.
It affects the fourth and fifth fingers generally. Dupuytren contracture is a type of fibromatosis like plantar and penile fibromatosis.
The ring finger is involved with the fifth and then the middle finger. Males develop disease three times more often and with greater severity.
Stages of Dupuytren disease as follows:
Proliferative phase
Involutional phase
Residual phase
Male predominance linked to androgen receptor expression. Rheumatoid arthritis may prevent Dupuytren disease development.
Pain is linked to nerve fibres in fibrous tissue or local nerve compression. Myofibroblasts align along tension lines in the nodule’s phase.
The nodular tissue disappears and acellular tissue with thick bands of collagen remains.
Dupuytren’s contracture is named after French surgeon Guillaume Dupuytren in 1833. The palmar aponeurosis extends from the wrist, crosses the ligament, and splits into bands for digits.
Spiral and lateral cords displace the neurovascular bundle centrally, while a central cord usually encases and directs it to one finger side.
McFarlane explains spiral cord displacement increases neurovascular bundle vulnerability to injury during surgery.
Dupuytren contracture affects 4-6% of Northern European descent individuals. Dupuytren disease is 4% prevalent in the U.S. due to immigration.
Northern Europe shows prevalence of 4 to 39% with 30% of men more than 60 years old. In 2004, Dupuytren disease incidence was 34.4 per 100,000 for British men aged 40-84.
Australia’s prevalence of 28% surpasses Spain’s 19% in men over 60 years. About 80% of those affected are male with onset typically in the fifth to sixth decade of life.
Investigators proposed hypotheses for Dupuytren disease pathogenesis. Localized ischemia leads to ATP conversion to hypoxanthine and xanthine dehydrogenase conversion to xanthine oxidase.
Free radicals lead to fibroblast growth and cytokines. Higher nerve growth factor levels promote fibroblast transformation to myofibroblasts.
LPA binding to myofibroblast receptors decreases cyclic AMP and increases intracellular calcium levels.
Excess type III collagen results from increased fibroblast density due to heightened stimulation, reduced apoptosis, and collagenase inhibitor imbalance.
The causes of Dupuytren Contracture are:
Genetic Predisposition
Cellular & Molecular mechanisms
Environmental & lifestyle factors
Hormonal & metabolic factors
Morbidity from Dupuytren contracture mainly affects lifestyle, as MCP and PIP joint contractures disrupt daily activities.
Aggressive disease associations, but Dupuytren contracture has no mortality.
Retrospective review of 593,606 patients found 15,416 developed trigger finger post-diagnosis.
Collect details including chief complaint, history of present illness, and medical history to understand clinical history of patient.
Range of Motion Assessment
Neurological & Vascular Examination
Inspection
Palmar skin changes
Palpation
Typical symptoms are:
Painless nodule in the palm, gradual formation of fibrous cords, loss of extension at MCP and PIP joints over time.
Clavus
Epidermoid Cyst
Fibroma
Tendon nodule
Lipoma
Dupuytren disease management includes various non-surgical and surgical options depending on disease severity, deformity, function limitations, and provider choice.
Contracture degree affects surgical outcomes in proximal but not metacarpophalangeal Dupuytren disease.
MCP joint groups had identical surgical success rates and contracture resolution.
PIP joint contractures over >300showed lower reduction index than groups 1 and 2.
Observation suits patients with painless Dupuytren disease and minimal contracture. Mild Dupuytren disease patients need follow-ups every 6-12 months for monitoring.
Heat and ultrasound stretching may benefit early Dupuytren contracture stages. Physical therapist may suggest custom splint or brace to stretch fingers more.
Occupational therapy enhances functionality through adaptive techniques.
Rheumatology
Use various tools with large grips/holding to reduce strain.
Increase use of adaptive gloves for smartphones/tablets while working.
Use lever-style door handles instead of round knobs for comfortable grip.
Use Jar and bottle openers to reduce load on fingers/hand.
Patient should learn and follow hand therapy exercises to improve flexibility and function.
Avoid smoking and excessive alcohol habits for long periods of time.
Proper awareness about Dupuytren Contracture should be provided and its related causes with management strategies.
Appointments with rheumatologist and preventing recurrence of disorder is an ongoing life-long effort.
Rheumatology
Collagenase Clostridium histolyticum:
It hydrolyzes collagen in native triple-helical conformation to cause lysis of collagen deposits.
Rheumatology
Triamcinolone:
It decreases inflammation to suppress migration of polymorphonuclear leukocytes.
Rheumatology
Fasciectomy surgery allows joint extension with earlier intervention benefits.
A study suggests performing surgical fasciectomy for Dupuytren disease and carpal tunnel release simultaneously, as the complication rate remains largely unchanged.
Percutaneous needle fasciotomy is a minimally invasive office procedure under anaesthesia.
Rheumatology
In the early phase, the focus is on observation and conservative management aspect of patient.
Pharmacologic therapy is effective in the treatment phase as it includes the use of enzymes and corticosteroids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the rheumatologist are scheduled to check the improvement of patients along with treatment response.
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