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20-September-2008 10:21:22 - Dupuytren's contracture Dupuytren's contracture Classification and external resources Dupuytren's contracture of the fourth digit ring finger. ICD-10 M72.0 ICD-9 728.6 OMIM 126900 DiseasesDB 4011 MedlinePlus 001233 eMedicine med/592 orthoped/81 plastic/299 pmr/42 derm/774 MeSH D004387 Dupuytren's contracture also known as Morbus Dupuytren or Dupuytren's disease, and sometimes misspelled as Dupuytren's constricture is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended straightened. It is named after Baron Guillaume Dupuytren, the surgeon who described an operation to correct the affliction. 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 painless. In patients with this condition, the tissues under the skin on the palm of the hand thicken and shorten so that the tendons connected to the fingers cannot move freely. The palmar aponeurosis becomes hyperplastic and undergoes contracture. Incidence increases after the age of 40; at this age men are affected more often than women. After the age of 80 the distribution is about even. Contents 1 Symptoms 2 Risk factors and possible causes 3 Treatment 4 Notable sufferers 5 References 6 External links Symptoms In Dupuytren's disease, the tough connective tissue within one's hand becomes abnormally thick, which can cause the fingers to curl, and can result in impaired function of the fingers, especially the small and ring fingers. It usually has a gradual onset, often beginning as a tender lump in the palm. Over time, pain associated with the condition tends to go away, but tough bands of tissue may develop. 1 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 progress more rapidly. Risk factors and possible causes Dupuytren's disease is a very specific affliction, and primarily affects: People of Scandinavian or Northern European ancestry,1 particularly those of Viking descent.2 Men rather than women Men are ten times as likely to develop the condition1 People over the age of 40, and People with a family history, 60 to 70% of those afflicted have a genetic predisposition to Dupuytren's Contracture3 Correlations have also been found between Dupuytren's contracture and: Smoking or drinking activity, Diabetes, Thyroid problems and Epilepsy Alcoholism and Liver Disease Pulmonary Tuberculosis Surgery of the hand may trigger growth of Dupuytren nodules and cords if an inclination existed before. Dupuytren's contracture may accompany fibrosing syndromes such as Peyronie's disease, Ledderhose's disease and Riedel's thyroiditis. There is no proven evidence that hand injuries or specific occupational exposures lead to a higher risk of developing Dupuytren's disease although there is some speculation that Dupuytren's may be caused or at least the onset may be triggered by physical trauma, such as manual 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.3 For an overview on research literature see also Dupuytren's work related?. Treatment Surgery in cases of severe contracture removes the contracture Radiation therapy specifically in early stages inhibits development of contracture Needle aponeurotomy releases the contracture Triamcinolone kenalog injections provide some relief 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, surgery is an option. 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 patient may need repeat surgery. In addition, the thickened fascia often is near to or wrapped around the digital nerves and arteries, so there is some risk of nerve and/or arterial injury. Needle aponeurotomy is a minimally 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 fingers straight. The advantage claimed for needle aponeurotomy is the very small amount of surgery required and the very rapid return to normal activities, but 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 aponeurotomy, but the cords are weakened through the injection of small amounts of an enzyme that dissolves them. Treatment of Dupuytren's disease with low-energy x-rays radiotherapy may cure the condition in the long term, specifically if applied in early stages of the disease. Notable sufferers Those of northern European descent are markedly at risk. Samuel Beckett, Ronald Reagan, Margaret Thatcher, and Bill Nighy are among the most famous patients. Interestingly, although this a predominantly caucasian disease, many Caribbean blacks can present with contractures, and all can trace a distant relative to Britain or Ireland.citation needed References ^ a b Your Orthopaedic Connection: Dupuytren's Contracture. ^ www.raft.ac.uk. ^ a b Dupuytren's Contracture - What is Dupuytren's Contracture. External links American Academy of Orthopaedic Surgeons v d e Diseases of the musculoskeletal system and connective tissue M, 710-739 Arthropathies Arthritis Septic arthritis - Reactive arthritis - Rheumatoid arthritis - Psoriatic arthritis - Felty syndrome - Juvenile idiopathic arthritis - Still's disease - crystal Gout, Chondrocalcinosis - Osteoarthritis Heberden's node, Bouchard's nodes - Monoarthritis/Polyarthritis Specific joints shoulder Winged scapula - elbow Cubitus valgus, Cubitus varus - hand Wrist drop, Boutonniere deformity, Swan neck deformity hip Protrusio acetabuli, Coxa valga, Coxa vara - leg Foot drop, Flat feet, Club foot, Unequal leg length - patella Luxating patella, Chondromalacia patellae - foot Bunion/hallux valgus, Hallux varus, Hallux rigidus, Hammer toe general terms Valgus deformity, Varus deformity Other Hemarthrosis - Arthralgia - Osteophyte - Hypermobility Systemic CT disorders vasculitis: Arteritis Polyarteritis nodosa, Takayasu's arteritis, Temporal arteritis - arterioles/capillaries Wegener's granulomatosis, Kawasaki disease, Churg-Strauss syndrome, Microscopic polyangiitis hypersensitivity/autoimmune: Hypersensitivity vasculitis - Goodpasture's syndrome - Systemic lupus erythematosus Drug-induced - Dermatomyositis Juvenile dermatomyositis - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis Dorsopathies spinal curvature Kyphosis, Lordosis, Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis Spondylopathies Ankylosing spondylitis, Spondylosis, Spinal stenosis - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain Radiculopathy, Neck pain, Sciatica, Low back pain Soft tissue disorders Muscle Myositis Pyomyositis - Myositis ossificans Fibrodysplasia ossificans progressiva Synovium and tendon Synovitis/Tenosynovitis Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome - Irritable hip - Ganglion cyst Bursa Bursitis Olecranon, Prepatellar, Trochanteric - Baker's cyst Fascia/fibroblastic Fasciitis Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis - Dupuytren's contracture - Fibromatosis Shoulder lesions Adhesive capsulitis - Rotator cuff tear - Subacromial bursitis Enthesis Enthesopathies Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis Other, NEC Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia Osteopathies disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone Pseudarthrosis, Stress fracture - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis Chondropathies Juvenile osteochondrosis Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease - Osteochondritis - Tietze's syndrome - Relapsing polychondritis See also congenital Retrieved from http://en..org/wiki/Dupuytren%27s_contracture Categories: Diseases involving the fasciae | Rare diseasesHidden categories: All articles with statements | Articles with statements since March 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Català Deutsch Español Français Italiano Latviešu Nederlands Polski This page was last modified on 13 August 2008, at 16:46
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