Orthopaedic MD

50 years experience with Dupuytren's contracture in the Erlangen University Hospital – A retrospective analysis of 2919 operated hands from 1956 to 2006 Bernd Loos , Valerij Puschkin and Raymund E Horch BMC Musculoskeletal Disorders 2007, 8:60 Prepublication

Dupuytren contracture, a disease of the palmar fascia, results in the thickening and shortening of fibrous bands in the hands and fingers. This disease entity belongs to the group of fibromatoses that include plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie disease), and fibromatosis of the dorsal proximal interphalangeal (PIP) joints (Garrod nodes or knuckle pads). Guillaume Dupuytren received recognition for the condition that came to be associated with his name because of his expertise on the clinical findings, pathogenesis, prognosis, and treatment of this disease; however, Plater and Cline respectively provided the earliest known records of Dupuytren contracture and its surgical treatment (Verheyden, 1983).
Synonyms and related keywords: Dupuytren's disease, Dupuytren disease, fibromatosis, fibromatoses, Dupuytren's contractures, palmar contracture, palmar fascia
Lee et al 2007

ynonyms and related keywords: Dupuytren contracture, palmar fascia, finger contracture, palmar fasciotomy, fasciectomy, dermofasciectomy, fibroblast proliferation, myofibroblasts, collagen deposition, type III collagen, basic fibroblast growth factor, platelet-derived growth factor, transforming growth factor-beta, glycosaminoglycans, metacarpophalangeal joint, MCP joint, proximal interphalangeal joint, PIP joint, distal interphalangeal joint, DIP joint, plantar fasciitis, Peyronie disease, trisomy 8 abnormality, trisomy 8 syndrome, palmar tendinitis, reflex sympathetic dystrophy
Dupuytren contracture is a benign, slowly progressive fibroproliferative disease of the palmar fascia that has no clear etiology or pathogenesis. Plater first described this condition in 1614, but it was Dupuytren who presented a meticulous anatomical study in 1831 that established the palmar fascia as the site of origin. The site of origin distinguishes it from other causes of finger contracture. Dupuytren also devised an effective surgical approach through palmar fasciotomy.

BMJ 2006;332:397-400 (18 February), W A Townley, R Baker, N Sheppard, A O Grobbelaar
Dupuytren's disease is a common and disabling fibroproliferative condition of the hand. It tends to strike patients in advancing age, causing progressive digital flexion contracture. Through its many associations, Dupuytren's disease crosses all borders of medicine and is often encountered by surgeon, physician, and general practitioner alike. To the medical student, it is dependable examination fodder—a name on many lists and a sign of many systems.

Wheeless' Textbook of Orthopaedics

Good patient information.
Dupuytren's disease is a thickening and shrinking of the layer of flesh just under the skin of the palm. It can cause lumps or dimples in the skin of the palm, and can draw the fingers down into a bent position. It is named after a surgeon who wrote about its treatment.

Discussion paper prepared for The Workplace Safety and Insurance Appeals Tribunal Ontario July 2002
Prepared by: Dr. Lawrence N. Hurst MD FRCS(C) Good overall illustrated account

J Korean Med Sci 2006; 21: 1128-32
Yoon-Kyoung Sung, Moon-Hyang Park*, Dae-Hyun Yoo Department of Internal Medicine, Division of Rheumatology and the Hospital for Rheumatic Diseases, Department of Pathology*, Hanyang University College of Medicine, Seoul, Korea
A 31-yr-old Korean woman was presented with 4-month history of bilateral hand swelling and stiffness. On clinical examination, she had a painful synovitis of both hands, wrists, knees and ankles. The radiologic and histological examinations con- firmed it with palmar fasciitis and polyarthritis syndrome (PFPAS). PFPAS is an un- common disorder characterized by progressive flexion contractures of both hands, inflammatory fasciitiis, fibrosis, and a generalized inflammatory arthritis. Although most reported cases of PFPAS have been associated with various malignancies, our patient have not been associated with malignancy during 24 months follow up period from her first symptom onset. Her symptoms were improved with moderate dose of corticosteroid and she is currently taking prednisone 5 mg daily without any evidence for internal malignancy. We present here in a young Korean patient with idiopathic PFPAS who was successfully treated with administration of corticosteroid.

Needle Aponeurotomy (Needle Aponevrotomy or NA) is a minimally invasive treatment for Dupuytren's contracture. In contrast to surgical treatment, which requires several months of recovery, Needle Aponeurotomy allows a more rapid recovery. In most cases, it is possible to return to near normal activities without bandages within a few days of treatment. Patient Information

Dupuytren's contracture is a progressively debilitating hand disease that involves an abnormal thickening and contracture of tough tissue in the palm, causing the fingers to curl. Although fasciectomy is usually recommended to release the contracture when hand function becomes severely limited, a less incapacitating and more inexpensive option — needle aponeurotomy — has recently become available
An interview with Charles Eaton

Review of reported studies from UK National Institute for Health and Clinical Excellence

P H Willemse, N H Mulder, H J van de Tempel, J G Aalders, and D T Sleijfer Ann Rheum Dis. 1991 January; 50(1): 53–54.
Abstract A 54 year old woman presented with an intra-abdominal adenocarcinoma of primary coelomic origin and a syndrome of palmar fasciitis and arthritis, which was exacerbated during treatment by combination chemotherapy with intravenous carboplatin 300 mg/m2 and cyclophosphamide 750 mg/m2, while the tumour responded well.

D Denschlag, E Riener, P Vaith, C Tempfer, and C Keck Ann Rheum Dis. 2004 September; 63(9): 1177–1178.

Presentation by J.P. Moermans, MD, PhD Université Libre de Bruxelles

Surgical Indications: - MCP contracture greater than 30 deg; - PIP joint: any significant contracture (more than 20);