Dupuytrens contracture: Difference between revisions

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{{SK}} Dupuytren contracture I, included; DUPC1; palmar fascial fibromatosis; palmar fibromatosis
{{SK}} Dupuytren contracture I, included; DUPC1; palmar fascial fibromatosis; palmar fibromatosis
==Overview==
==Overview==
'''Dupuytren's contracture''' (also known as '''Morbus Dupuytren''') is a fixed [[flexion]] [[contracture]] of the [[hand]] where the [[finger]]s bend towards the palm and cannot be fully extended (straightened). It is named after the famous [[surgery|surgeon]] [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], who described an [[Surgery|operation]] to correct the affliction.
'''Dupuytren's contracture''' (also known as '''Morbus Dupuytren''') is an abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.. It is named after the famous [[surgery|surgeon]] [[Guillaume Dupuytren|Baron Guillaume Dupuytren]], who described an [[Surgery|operation]] to correct the affliction. It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]]. Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include family history, diabetes, antiepileptic medications, liver disease, smoking, alcoholism and manual work. The incidence of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] increases with age; the [[median]] age at diagnosis is 50-70 years. [[men]] are affected more often than [[women]].
 
The [[ring finger]] and [[little finger]] are the fingers most commonly affected; the [[middle finger]] may be affected in advanced cases, but [[index finger]] and [[thumb]] are nearly always spared. Dupuytren's contracture progresses slowly and is usually [[Pain and nociception|painless]]. In patients with this condition, the [[Biological tissue|tissue]]s under the [[skin]] on the palm of the hand thicken and shorten so that the [[tendon]]s connected to the fingers cannot move freely. The [[palmar aponeurosis]] becomes hyperplastic and undergoes contracture. As a result, the affected fingers start to bend more and more and cannot be straightened.  
 
[[Incidence]] increases after the [[senescence|age]] of 40; at this age [[men]] are affected more often than [[women]]. After the age of 80 the distribution is about even.


==Historical Perspective==
==Historical Perspective==
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*The exact pathogenesis of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] is not fully understood.
*The exact pathogenesis of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] is not fully understood.
*It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]]..
*It is thought that Dupuytren's contracture is the result of [[Microvascular disease|microvascular]] [[angiopathy]].<ref name="pmidhttps://doi.org/10.1136/bmj.n13085">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>


===Associated Conditions===
===Associated Conditions===
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*[[Liver diseases|Liver disease]]
*[[Liver diseases|Liver disease]]
*[[Alcoholism]] and [[smoking]]
*[[Alcoholism]] and [[smoking]]
<br />


==Causes==
==Causes==
The cause of Dupuytren's contracture has not been identified.  
The cause of Dupuytren's contracture has not been identified.  


==Symptoms==
== Epidemiology and Demographics ==
<br />
 
==Epidemiology and Demographics==


===Prevalence===
===Prevalence===


*The [[prevalence]] of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] among the UK population is 3-5%.
*The [[prevalence]] of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] among the UK population is 3-5%.<ref name="pmid21486483">{{cite journal| author=Gerber RA, Perry R, Thompson R, Bainbridge C| title=Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England. | journal=BMC Musculoskelet Disord | year= 2011 | volume= 12 | issue=  | pages= 73 | pmid=21486483 | doi=10.1186/1471-2474-12-73 | pmc=3103491 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21486483  }}</ref>


===Age===
===Age===
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===Race===
===Race===


*Dupuytren's contracture usually affects individuals of the northern Europeans race (Icelandic and Scandinavian populations).
*Dupuytren's contracture usually affects individuals of the northern Europeans race (Icelandic and Scandinavian populations).<ref name="pmid10760640">{{cite journal| author=Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T| title=Epidemiology of Dupuytren's disease: clinical, serological, and social assessment. The Reykjavik Study. | journal=J Clin Epidemiol | year= 2000 | volume= 53 | issue= 3 | pages= 291-6 | pmid=10760640 | doi=10.1016/s0895-4356(99)00145-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10760640  }}</ref>


===Gender===
===Gender===


*[[Male|Males]] are more commonly affected by Dupuytren's contracture than [[Female|females]]. The male to female [[ratio]] is approximately 3 to 1.
*[[Male|Males]] are more commonly affected by Dupuytren's contracture than [[Female|females]]. The male to female [[ratio]] is approximately 3 to 1.<ref name="pmidhttps://doi.org/10.1136/bmj.n13084">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>
 
<br />


==Risk Factors==
==Risk Factors==
Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include:
Common risk factors in the development of [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] include:


*[[Family history]]: [[genetic predisposition]] may account for 80% of cases.
*[[Family history]]: [[genetic predisposition]] may account for 80% of cases.<ref name="pmid24835475">{{cite journal| author=Larsen S, Krogsgaard DG, Aagaard Larsen L, Iachina M, Skytthe A, Frederiksen H| title=Genetic and environmental influences in Dupuytren's disease: a study of 30,330 Danish twin pairs. | journal=J Hand Surg Eur Vol | year= 2015 | volume= 40 | issue= 2 | pages= 171-6 | pmid=24835475 | doi=10.1177/1753193414535720 | pmc=4810018 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24835475  }}</ref>
*[[Diabetes]] and its medications
*[[Diabetes]] and its medications<ref name="pmid15336742">{{cite journal| author=Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R| title=Dupuytren's disease risk factors. | journal=J Hand Surg Br | year= 2004 | volume= 29 | issue= 5 | pages= 423-6 | pmid=15336742 | doi=10.1016/j.jhsb.2004.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15336742  }}</ref>
*[[Smoking]]
*[[Smoking]]<ref name="pmid15485739">{{cite journal| author=Godtfredsen NS, Lucht H, Prescott E, Sørensen TI, Grønbaek M| title=A prospective study linked both alcohol and tobacco to Dupuytren's disease. | journal=J Clin Epidemiol | year= 2004 | volume= 57 | issue= 8 | pages= 858-63 | pmid=15485739 | doi=10.1016/j.jclinepi.2003.11.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15485739  }}</ref>
*[[Alcohol]] intake
*[[Alcohol]] intake
*[[Antiepileptics|Antiepileptic]] medications
*[[Antiepileptics|Antiepileptic]] medications<ref name="pmid25288296">{{cite journal| author=Nunn AC, Schreuder FB| title=Dupuytren's contracture: emerging insight into a Viking disease. | journal=Hand Surg | year= 2014 | volume= 19 | issue= 3 | pages= 481-90 | pmid=25288296 | doi=10.1142/S0218810414300058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25288296  }}</ref>
*There is also some speculation that [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] may be caused by [[physical trauma]], such as manual [[Labor (childbirth)|labor]] or other over-exertion of the hands. However, the fact that Dupuytren's is not connected with handedness casts some doubt on this claim.
*There is also some speculation that [[Dupuytren's contracture (patient information)|Dupuytren's contracture]] may be caused by [[physical trauma]], such as manual [[Labor (childbirth)|labor]] or other over-exertion of the hands. However, the fact that Dupuytren's is not connected with handedness casts some doubt on this claim.
*[[Surgery]] of the [[hand]] may trigger growth of Dupuytren nodules and cords if an inclination existed before.
*[[Surgery]] of the [[hand]] may trigger growth of Dupuytren nodules and cords if an inclination existed before.
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===History and Symptoms===
===History and Symptoms===


*Symptoms of '''Dupuytren's disease''' include abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the small and ring fingers.
*Symptoms of '''Dupuytren's disease''' include abnormal [[Thickening of the heart muscle|thickening]] of the hand causing curling of [[fingers]] and impaired function of the fingers, especially the little and ring fingers.
*It usually has a gradual onset, often beginning as a [[Tenderness (medicine)|tender]] [[lump]] in the [[Palmar|palm]].
*It usually has a gradual onset, often beginning as a [[Tenderness (medicine)|tender]] [[lump]] in the [[Palmar|palm]].
*It often starts as a [[Nodule (medicine)|nodule]], usually in line with the [[ring finger]].<ref name="pmidhttps://doi.org/10.1136/bmj.n1308">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>
*It often starts as a [[Nodule (medicine)|nodule]], usually in line with the [[ring finger]].
*Over time, [[pain]] associated with the condition tends to go away, but tough bands of tissue may develop.
*Over time, [[pain]] associated with the condition tends to go away, but tough bands of tissue may develop.
*These bands, which are the source of the reduced [[mobility]] commonly associated with the condition, are visible on the surface of the [[Palmar|palm]], and may appear similar to a small [[callus]].
*These bands, which are the source of the reduced [[mobility]] commonly associated with the condition, are visible on the surface of the [[Palmar|palm]], and may appear similar to a small [[callus]].
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==Treatment==
==Treatment==


=== Medical Therapy ===
===Medical Therapy===
 
*Pharmacologic medical therapies for Dupuytren's disease include pain management and corticosteroid injection into the nodules,
*In some cases, repeated corticosteroid injections may cause softening of the nodules and slow down the disease progression.
*Most cases with simple nodules and without significant functional impairment benefit from conservative medical therapy.
 
=== Interventions ===


* Pharmacologic medical therapies for Dupuytren's disease include pain management and corticosteroid injection into the nodules,<ref name="pmidhttps://doi.org/10.1136/bmj.n13082">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>
==== Collagenase clostridium histolyticum (CCH) injections ====
* In some cases, repeated corticosteroid injections may cause softening of the nodules and slow down the disease progression.
* Most cases with simple nodules and without significant functional impairment benefit from conservative medical therapy.


=== Surgery ===
* The [[mechanism of action]] is to weaken the [[contracted]] [[cord]] by breaking down [[collagen]].<ref name="pmid19726771">{{cite journal| author=Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA | display-authors=etal| title=Injectable collagenase clostridium histolyticum for Dupuytren's contracture. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 10 | pages= 968-79 | pmid=19726771 | doi=10.1056/NEJMoa0810866 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19726771  }}</ref>
[[Surgery]] is not the first-line treatment option for patients with [[Dupuytren's contracture (patient information)|Dupuytren's]] disease. Surgery is usually reserved for patients with either:
* It is done in an outpatient practice but requires another clinic visit to snap the cord.
* I t is generally safe; however several [[Complication (medicine)|complications]] were reported, such as [[tendon]] [[rupture]] and pulley injury.<ref name="pmid23200951">{{cite journal| author=Peimer CA, Blazar P, Coleman S, Kaplan FT, Smith T, Tursi JP | display-authors=etal| title=Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data. | journal=J Hand Surg Am | year= 2013 | volume= 38 | issue= 1 | pages= 12-22 | pmid=23200951 | doi=10.1016/j.jhsa.2012.09.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23200951  }}</ref>
* CCH injectiont is available in only North America after its withdrawal from European, Australian, and Asian markets.<ref name="pmid31810821">{{cite journal| author=Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N| title=The End of an Era: Withdrawal of Xiapex (Clostridium histolyticum Collagenase) from the European Market. | journal=Eur Urol | year= 2020 | volume= 77 | issue= 5 | pages= 660-661 | pmid=31810821 | doi=10.1016/j.eururo.2019.11.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31810821  }}</ref>


* Rapid progression over a few months
===Surgery===
* Severe thumb [[Contracture|contractures]] with functional impairment
[[Surgery]] is not the first-line treatment option for patients with [[Dupuytren's contracture (patient information)|Dupuytren's]] disease. Surgery is usually reserved for patients with either:<ref name="pmidhttps://doi.org/10.1136/bmj.n13083">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1136/bmj.n1308 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }}</ref>
* More than 30° [[metacarpophalangeal joint]] contracture or 10-20° [[Proximal interphalangeal joints|proximal interphalangeal joint]] [[contracture]]  <br />


*Radiation therapy (specifically in early stages inhibits development of contracture)
*Rapid progression over a few months
*Needle aponeurotomy (releases the contracture)
*Severe thumb [[Contracture|contractures]] with functional impairment
*[[Triamcinolone]] (kenalog) injections provide some relief
*More than 30° [[metacarpophalangeal joint]] contracture or 10-20° [[Proximal interphalangeal joints|proximal interphalangeal joint]] [[contracture]]  


Surgical management consists of opening the skin over the affected cords and excising, removing, the fibrous tissue. The fingers may then be brought out to length with the help of postoperative therapy. The procedure is not curative in that remaining non-affected fascia may still develop Dupuytren's disease later on, and therefore the patients may need repeat surgery. In addition, the thickened fascia often invests the digital nerves and arteries, so there is some risk of nerve and/or arterial injury.
The choice of the type of surgery depends the following variables:


Treatment of Dupuytren's disease with low energy x-rays (radiotherapy) may cure Morbus Dupuytren on a long term, specifically if applied in early stages of the disease. Needle aponevrotomy is a minimal invasive technique where the cords are weakened through the insertion and manipulation of a small needle. Once weakened, the offending cords may be snapped by simply pulling the finger(s) straight. The nodules are not removed and might start growing again. Currently in phase III of [[Food and Drug Administration]] (FDA) approval is another promising therapy, the injection of [[collagenase]]. This procedure is similar to needle aponevrotomy, however the chords are weakened through the injection of small amounts of an enzyme that dissolves them.
*Severity of the disease  
*Individual characteristics (such as [[age]], [[Occupational Medicine|occupation]], degree of functional disability)
*Patient and/or physician preference


Dupuytren's contracture is not a dangerous condition, and often no treatment is necessary. Even when treatment is used, there is no permanent way to stop or cure the infliction.  If there is a painful lump present, an injection can often help alleviate the pain.  If pain persists or the function of the hand becomes seriously impaired, individuals often choose to have surgery.  This surgery usually entails removing or separating the thickened bands, and is unlikely to cause any major complications or side effects, although in serious cases, some minor skin grafting may be necessary.  Any damaged skin or tissue in the surgically affected area of the hand will heal fairly quickly, and reducing bloodflow during the healing period helps reduce pain.  This may be done by keeping the hand raised or elevated so that blood does not pool in the affected area.
Surgical options include:


After surgical treatment, the condition may worsen in inadequately excised diseased tissue or re-develop in previously normal tissue.
* '''[[Percutaneous]] [[needle]] [[fasciotomy]] (PNF):''' involves division of the cord using a needle. It is generally effective and safe with no [[Complication (medicine)|complications]]; however [[tendon]] and [[Digital clubbing|digital]] [[nerve]] and [[Blood vessel|vessel]] damage were reported in some cases. Its efficacy is low in the management of extensive [[Contracture|contractures]] or contractures involving the [[Interphalangeal articulations of hand|proximal interphalangeal joints]]. The recurrence rate is high.<ref name="pmid16713831">{{cite journal| author=van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM| title=A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study. | journal=J Hand Surg Am | year= 2006 | volume= 31 | issue= 5 | pages= 717-25 | pmid=16713831 | doi=10.1016/j.jhsa.2006.02.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16713831  }}</ref><ref name="pmid26648251">{{cite journal| author=Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J | display-authors=etal| title=Surgery for Dupuytren's contracture of the fingers. | journal=Cochrane Database Syst Rev | year= 2015 | volume=  | issue= 12 | pages= CD010143 | pmid=26648251 | doi=10.1002/14651858.CD010143.pub2 | pmc=6464957 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26648251  }}</ref><ref name="pmid30012049">{{cite journal| author=Scherman P, Jenmalm P, Dahlin LB| title=Three-year recurrence of Dupuytren's contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial. | journal=J Hand Surg Eur Vol | year= 2018 | volume= 43 | issue= 8 | pages= 836-840 | pmid=30012049 | doi=10.1177/1753193418786947 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30012049  }}</ref>
* '''[[Fasciectomy]]''' '''either partial (segmental aponeurectomy) or complete (limited fasciectomy):''' involves excision of the cord with higher rate of [[complications]] PNF.<ref name="pmid10697321">{{cite journal| author=Armstrong JR, Hurren JS, Logan AM| title=Dermofasciectomy in the management of Dupuytren's disease. | journal=J Bone Joint Surg Br | year= 2000 | volume= 82 | issue= 1 | pages= 90-4 | pmid=10697321 | doi=10.1302/0301-620x.82b1.9808 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10697321  }}</ref>
* '''Dermofasciectomy:''' a more [[Invasive (medical)|invasive]] procedure that involves excising the whole diseased tissue, along with the overlying [[subcutaneous fat]] and [[skin]]. It is reserved for more severe cases with extensive skin involvement when the other surgical options have failed. The complication rate is the highest among the three surgical options. The [[Recurrence plot|recurrence]] rate is low.<ref name="pmid6379077">{{cite journal| author=Tonkin MA, Burke FD, Varian JP| title=Dupuytren's contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. | journal=J Hand Surg Br | year= 1984 | volume= 9 | issue= 2 | pages= 156-62 | pmid=6379077 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6379077  }}</ref>
 
<br />


==External links==
==External links==

Revision as of 07:02, 7 August 2021

Dupuytren's contracture
Dupuytren's contracture of the fourth digit (ring finger).
ICD-10 M72.0
ICD-9 728.6
OMIM 126900
DiseasesDB 4011
MedlinePlus 001233

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Editors-In-Chief: Matthew I. Leibman, M.D.[1]; Mark R. Belsky, M.D.[2]; David E. Ruchelsman, M.D.[3]Kiran Singh, M.D. [4]

Synonyms and keywords: Dupuytren contracture I, included; DUPC1; palmar fascial fibromatosis; palmar fibromatosis

Overview

Dupuytren's contracture (also known as Morbus Dupuytren) is an abnormal thickening of the hand causing curling of fingers and impaired function of the fingers, especially the little and ring fingers.. It is named after the famous surgeon Baron Guillaume Dupuytren, who described an operation to correct the affliction. It is thought that Dupuytren's contracture is the result of microvascular angiopathy. Common risk factors in the development of Dupuytren's contracture include family history, diabetes, antiepileptic medications, liver disease, smoking, alcoholism and manual work. The incidence of Dupuytren's contracture increases with age; the median age at diagnosis is 50-70 years. men are affected more often than women.

Historical Perspective

Pathophysiology

Pathogenesis

Associated Conditions

Causes

The cause of Dupuytren's contracture has not been identified.

Epidemiology and Demographics

Prevalence

Age

Race

  • Dupuytren's contracture usually affects individuals of the northern Europeans race (Icelandic and Scandinavian populations).[3]

Gender

  • Males are more commonly affected by Dupuytren's contracture than females. The male to female ratio is approximately 3 to 1.[4]

Risk Factors

Common risk factors in the development of Dupuytren's contracture include:

Natural History, Complications and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Study of Choice

Dupuytren’s disease is primarily diagnosed based on the clinical presentation.

History and Symptoms

  • Symptoms of Dupuytren's disease include abnormal thickening of the hand causing curling of fingers and impaired function of the fingers, especially the little and ring fingers.
  • It usually has a gradual onset, often beginning as a tender lump in the palm.
  • It often starts as a nodule, usually in line with the ring finger.
  • Over time, pain associated with the condition tends to go away, but tough bands of tissue may develop.
  • These bands, which are the source of the reduced mobility commonly associated with the condition, are visible on the surface of the palm, and may appear similar to a small callus.
  • It commonly develops in both hands, and has no connection to dominant- or non-dominant hands, nor any correlation with right- or left-handedness.
  • The contracture sets on very slowly, especially in women. However, when present in both hands, and when there is associated foot involvement, it tends to accelerate more rapidly.

Physical Examination

Skin

Hand

Treatment

Medical Therapy

  • Pharmacologic medical therapies for Dupuytren's disease include pain management and corticosteroid injection into the nodules,
  • In some cases, repeated corticosteroid injections may cause softening of the nodules and slow down the disease progression.
  • Most cases with simple nodules and without significant functional impairment benefit from conservative medical therapy.

Interventions

Collagenase clostridium histolyticum (CCH) injections

  • The mechanism of action is to weaken the contracted cord by breaking down collagen.[9]
  • It is done in an outpatient practice but requires another clinic visit to snap the cord.
  • I t is generally safe; however several complications were reported, such as tendon rupture and pulley injury.[10]
  • CCH injectiont is available in only North America after its withdrawal from European, Australian, and Asian markets.[11]

Surgery

Surgery is not the first-line treatment option for patients with Dupuytren's disease. Surgery is usually reserved for patients with either:[12]

The choice of the type of surgery depends the following variables:

  • Severity of the disease
  • Individual characteristics (such as age, occupation, degree of functional disability)
  • Patient and/or physician preference

Surgical options include:


External links

http://www.nlm.nih.gov/medlineplus/ency/article/001233.htm

Template:Diseases of the musculoskeletal system and connective tissue


de:Morbus Dupuytren it:Malattia di Dupuytren nl:Ziekte van Dupuytren


Template:WikiDoc Sources

  1. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1136/bmj.n1308 Check |pmid= value (help).
  2. ↑ Gerber RA, Perry R, Thompson R, Bainbridge C (2011). "Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England". BMC Musculoskelet Disord. 12: 73. doi:10.1186/1471-2474-12-73. PMC 3103491. PMID 21486483.
  3. ↑ Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T (2000). "Epidemiology of Dupuytren's disease: clinical, serological, and social assessment. The Reykjavik Study". J Clin Epidemiol. 53 (3): 291–6. doi:10.1016/s0895-4356(99)00145-6. PMID 10760640.
  4. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1136/bmj.n1308 Check |pmid= value (help).
  5. ↑ Larsen S, Krogsgaard DG, Aagaard Larsen L, Iachina M, Skytthe A, Frederiksen H (2015). "Genetic and environmental influences in Dupuytren's disease: a study of 30,330 Danish twin pairs". J Hand Surg Eur Vol. 40 (2): 171–6. doi:10.1177/1753193414535720. PMC 4810018. PMID 24835475.
  6. ↑ Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R (2004). "Dupuytren's disease risk factors". J Hand Surg Br. 29 (5): 423–6. doi:10.1016/j.jhsb.2004.06.006. PMID 15336742.
  7. ↑ Godtfredsen NS, Lucht H, Prescott E, Sørensen TI, Grønbaek M (2004). "A prospective study linked both alcohol and tobacco to Dupuytren's disease". J Clin Epidemiol. 57 (8): 858–63. doi:10.1016/j.jclinepi.2003.11.015. PMID 15485739.
  8. ↑ Nunn AC, Schreuder FB (2014). "Dupuytren's contracture: emerging insight into a Viking disease". Hand Surg. 19 (3): 481–90. doi:10.1142/S0218810414300058. PMID 25288296.
  9. ↑ Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA; et al. (2009). "Injectable collagenase clostridium histolyticum for Dupuytren's contracture". N Engl J Med. 361 (10): 968–79. doi:10.1056/NEJMoa0810866. PMID 19726771.
  10. ↑ Peimer CA, Blazar P, Coleman S, Kaplan FT, Smith T, Tursi JP; et al. (2013). "Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data". J Hand Surg Am. 38 (1): 12–22. doi:10.1016/j.jhsa.2012.09.028. PMID 23200951.
  11. ↑ Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N (2020). "The End of an Era: Withdrawal of Xiapex (Clostridium histolyticum Collagenase) from the European Market". Eur Urol. 77 (5): 660–661. doi:10.1016/j.eururo.2019.11.019. PMID 31810821.
  12. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1136/bmj.n1308 Check |pmid= value (help).
  13. ↑ van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM (2006). "A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study". J Hand Surg Am. 31 (5): 717–25. doi:10.1016/j.jhsa.2006.02.021. PMID 16713831.
  14. ↑ Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J; et al. (2015). "Surgery for Dupuytren's contracture of the fingers". Cochrane Database Syst Rev (12): CD010143. doi:10.1002/14651858.CD010143.pub2. PMC 6464957. PMID 26648251.
  15. ↑ Scherman P, Jenmalm P, Dahlin LB (2018). "Three-year recurrence of Dupuytren's contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial". J Hand Surg Eur Vol. 43 (8): 836–840. doi:10.1177/1753193418786947. PMID 30012049.
  16. ↑ Armstrong JR, Hurren JS, Logan AM (2000). "Dermofasciectomy in the management of Dupuytren's disease". J Bone Joint Surg Br. 82 (1): 90–4. doi:10.1302/0301-620x.82b1.9808. PMID 10697321.
  17. ↑ Tonkin MA, Burke FD, Varian JP (1984). "Dupuytren's contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients". J Hand Surg Br. 9 (2): 156–62. PMID 6379077.
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