Chapter 32 - Dupuytren Contracture

Question 1

What cells have over proliferated in palmar fascia in dupuytrens?

Answer 1

fibroblasts, contractile myofibroblasts

Question 2

fiber orientation at the level of the distal palmar crease

Answer 2

transverse fibers of the palmar fascia run just dorsal to the pre-tendinou bands and are not involved in disease process -> neurovascular bundles run deep (dorsal) to these transverse fibers so they act as landmark

Question 3

of greyson and cleland ligaments which are involved in dupuytrens?

Answer 3

greyson ligaments

greyson to the ground (palmar)
cleland ceiling (dorsal)

Question 4

spiral cord anatomy

Answer 4

emerge from either side of the pretendinous band and pass distally along either side of the flexor sheath - passes DORSAL to the neurovascular bundle

Question 5

spiral cords displace the NV bundle how?

Answer 5

palmarly, midline, and proximally

Question 6

what type of collagen predominates in dupuytrens?

Answer 6

type III

Question 7

genetic inheritance of dupuytrens?

Answer 7

AD

Question 8

what medical co-morbidity is common in dupuytren’s?

Answer 8

DM, seizure disorder (maybe meds), HIV, and alcoholism

Question 9

recurrence following collagenase treatement in dupuytrens?

Answer 9

PIP recurrence more common than MCP (66 vs 39%)

Question 10

5 year recurrence rate after needle aponeurotomy

Answer 10

85%

Question 11

Which contracture is easier and more reliably correctable in DUpuytren’s?

Answer 11

MCP easier to correct and more likely to stay corrected than PIP