Dupuytren's Disease

Question 1

Dupuytren’s disease

Answer 1

benign connective tissue disorder affecting the palmar fascia that can lead to flexion contracture of the MP and PIP joints

Question 2

Dupuytren’s: epidemology

Answer 2

most common in older men of northern European descent
most common on ulnar side of hand
early onset = more severe

Question 3

Dupuytren’s and other diseases

Answer 3

notable relationship between Dupytren’s and:

1. diabetes
2. alcoholism
3. epilepsy

Question 4

Dupuytren’s: signs and symptoms

Answer 4

characterized by nodules and cords near distal palmar crease on ulnar side of hand
itching/burning or asymptomatic

Question 5

Dupuytren’s: nodules

Answer 5

comprised of hyper-cellular collagen bundles

• first visible evidence
• may rapidly or slowly enlarge or may remain stable

Question 6

Dupuytren’s: cords (5)

Answer 6

less cellular than nodules

• appear at a later stage
• can cause contractures
  1. pretendinous cord (MP)
  2. lateral digital cord (PIP)
  3. spiral cord (PIP)
  4. central cord (PIP)
  5. retrovascular cord (PIP/DIP)

Question 7

Psuedo-Boutonniere

Answer 7

flexed PIP and hyperextended DIP
secondary effect of PIP contracture that creates an imbalance between flexor and extensor tendons as they act across the DIP and progressive overstretching of the DIP volar plate

Question 8

Dupuytren’s: operative treatment (3)

Answer 8

1. percutaneous needle aponeurotomy
2. fasciotomy
3. fasciectomy

Question 9

Dupuytren’s: percutaneous needle aponeurotomy

Answer 9

hypodermic needle stabbed through the skin at multiple locations overlying the contracting cord to make a series of micro-lacerations;
weakened cord eventually ruptures and contracted joint extends to various lengths
*least invasive surgical intervention
*rapid increase in extension, minimal recovery time, and can be performed under a local
*ideal for elderly w/ comorbidities

Question 10

Dupuytren’s: fasciotomy

Answer 10

simple division of a cord without resection of tissues

*most have restricted its use to palmar cords

Question 11

Dupuytren’s: fasciectomy

Answer 11

most widely-used to treat Dupuytren’s
procedure involves generous skin incisions and careful dissection and excision of just the involved diseased fascia
*Z-plasty skin grafts, sutures, or wound left open to heal

Question 12

Dupuytren’s: fasciectomy complications (6)

Answer 12

1. hematoma
2. nerve and vessel injury
3. delay in healing
4. joint stiffness
5. loss of PIP flexion
6. CRPS

Question 13

Dupuytren’s: post-op therapy (6)

Answer 13

see in first few days

1. dressing change
2. wound care
3. orthosis
4. edema management
5. gentle exercises
6. scar management

Question 14

Dupuytren’s: collagenase enzymatic fasciotomy

Answer 14

Xiaflex
injected into the cord
patient returns in 24 hrs to extend the finger
send to therapist for orthosis