4. Orthopaedic Problems of the Hand - Dupuytren's Disease

Question 1

What are the main Elective Hand Conditions?

Answer 1

1. Dupuytren’s Disease (Contracture)
2. Trigger Finger
3. De Quervain’s Tenovaginitis
4. Nerve Entrapment:
5. a) Carpal Tunnel Syndrome
6. b) Cubital Tunnel Syndrome
7. Ganglion
8. Osteoarthritis on the Base of the Thumb

Question 2

Who gets Dupuytren’s Disease (Contracture)?

Answer 2

Vast Majority are white males:
15-64’s = 8:1 Males
75’s+ = 2:1 Males

Question 3

What is the genetic component of Dupuytren’s Disease?

Answer 3

Onset May be Sex-Linked:

1. Autosomal Dominant - Variable Penetrance
2. Sporadic in 30% of Cases

Question 4

What Diseases have associations with Dupuytren’s Disease?

Answer 4

1. Diabetes
2. Alcohol
3. Tobacco
4. HIV
5. Epilepsy

Question 5

What are the features of Dupuytren’s Diathesis?

Answer 5

1. Early onset of Dupuytren’s Disease
2. It is found Bilaterally
3. It occurs with a Family History
4. It is an Ectopic Disease

Question 6

What is the Pathology of Dupuytren’s Disease?

Answer 6

Myofibroblast proliferation and collagen deposition lead to a slowly progressive thickening and shortening of the Palmar Fascia. This causes debilitating digital contractures of the MCP and IP Joints in the 4th/5th Digit

Question 7

What are the Functional Problems of Dupuytren’s Disease?

Answer 7

1. Usually not painful
2. Loss of Finger Extension - active or passive
3. Hard to do simple tasks: Hands in pockets, gripping things, washing face etc.

Question 8

What are the Non-Operative treatment of Dupuytren’s Disease?

Answer 8

1. Observe
2. Radiotherapy
   Note - Splint’s don’t work

Question 9

What are the Operative treatment of Dupuytren’s Disease?

Answer 9

1. Partial Fasciectomy
2. Dermo-Fasciectomy
3. Arthrodesis
4. Amputation
   Less common
5. Percutaneous Needle Fasciotomy
6. Collagenase

Question 10

1. What is the most common treatment of Dupuytren’s Disease in the UK?
2. Why

Answer 10

1. Partial Fasciectomy
2. Good correction can be achieved but cannot be cured (50% recurrence rate at 5 years) - wound takes 2-3 weeks to heal
   Note - the stiffness requires physiotherapy

Question 11

What is the main difference between the Partial Fasciectomy and the Dermo-Fasciectomy?

Answer 11

The Dermo-Fasciectomy is a more radical treatment - however removal of skin may reduce recurrence rates)
Note - this requires intensive physiotherapy

Question 12

What are the advantages of a Percutaneous Needle Fasciotomy?

Answer 12

1. Quick
2. No wounds - return to normal activities in 3 days
3. Does not prevent traditional surgery in the future
4. Can be repeated

Question 13

What are the disadvantages of a Percutaneous Needle Fasciotomy?

Answer 13

1. Higher recurrence rates

2. Risk of Nerve injury

Question 14

What are the Disadvantages of Collagenase?

Answer 14

1. Cost
2. High recurrence rate
3. 3 Flexor Tendons rupture
4. No information on long term recurrence rates