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Dupuytren’s Contracture

Who gets it?

  • Men : women 2:1 to 10:1

  • World wide 3-6% incidence increases with age

  • With age the ratio levels out

  • ‘Celtic disease’: Vikings and northern europeans

  • Common in Japan but not in other Asian nations or in African nation.

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  • It is mostly genetic but progression is associated with

    • Diabetes

    • Vibrating machinery

    • Alcohol intake

    • Epilepsy meds

    • Rarely work related, but a single injury can trigger or expedite development of Dupuytrens in a genetically predisposed individual

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Progression

  • Nodules

  • Pathological Cords

  • Cords Thicken and Shorten

  • Cause flexion deformities and contractures

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What is it?

  • Palmar and digital fascia (bands) firmly supports the skin so that we can grip objects.

  • These hypertrophy and contract to form pathologic cords and deformity

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Dupuytren’s Diathesis ( high risk of rapid progression and recurrence)

  • Caucasian

  • Family history

  • Bilateral disease

  • Ectopic lesions (plantar fibromatosis etc.)

  • Male gender

  • Onset younger than 50yo

When does it need treatment?

  • Nodules – usually the discomfort in nodules settles and no treatment is necessary

  • If it is very bothersome an intra nodular steroid injection can help settle discomfort.

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  • Metacarpophalangeal flexion deformity

    • Does not pass ‘table top test’

    • Struggles to get hand in small spaces (pocket/hand bag)

    • Usually about 30 deg

  • DIPJ flexion deformity 

    • Any significant flexion deformity

    • Usually about 20 deg

    • The PIPJ becomes stiff and a joint release is required

  • Recurrence rate, hand function after surgery  is affected by the degree of initial contracture

  • It is probably best not to leave intervention too late

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Stretching and Splints

There is no conclusive evidence that either modality slows or prevents the progression of Dupuytren’s.

  • Done in the rooms

  • Local to skin only

  • (cords are insensate)

  • Nerve and tendon funtion monitored throughout procedure

  • Safe in the palm, but more risky in the finger

  • Can not address joint or skin contracture (risk of skin tear)

  • Recurrence rate about 50-70 % over 3 years Varying reports

Needle aponeurotomy

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Needle aponeurotomy - Recovery

  • Light dressings immediately after procedure

  • Fingers will be numb for 2-6 hours

  • Please move and stretch fingers

  • Keep small wounds covered and dry until healed

  • Follow up at the rooms in 2-3 weeks, or earlier if there are skin tears

  • Self care is usually possible almost immediately

  • Moderately heavy tasks by 2-3weeks

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