Flashcards in 4. Orthopaedic Problems of the Hand - Dupuytren's Disease Deck (14):
What are the main Elective Hand Conditions?
1. Dupuytren's Disease (Contracture)
2. Trigger Finger
3. De Quervain's Tenovaginitis
4. Nerve Entrapment:
4. a) Carpal Tunnel Syndrome
4. b) Cubital Tunnel Syndrome
6. Osteoarthritis on the Base of the Thumb
Who gets Dupuytren's Disease (Contracture)?
Vast Majority are white males:
15-64's = 8:1 Males
75's+ = 2:1 Males
What is the genetic component of Dupuytren's Disease?
Onset May be Sex-Linked:
1. Autosomal Dominant - Variable Penetrance
2. Sporadic in 30% of Cases
What Diseases have associations with Dupuytren's Disease?
What are the features of Dupuytren's Diathesis?
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
What is the Pathology of Dupuytren's Disease?
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
What are the Functional Problems of Dupuytren's Disease?
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.
What are the Non-Operative treatment of Dupuytren's Disease?
Note - Splint's don't work
What are the Operative treatment of Dupuytren's Disease?
1. Partial Fasciectomy
5. Percutaneous Needle Fasciotomy
1. What is the most common treatment of Dupuytren's Disease in the UK?
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
What is the main difference between the Partial Fasciectomy and the Dermo-Fasciectomy?
The Dermo-Fasciectomy is a more radical treatment - however removal of skin may reduce recurrence rates)
Note - this requires intensive physiotherapy
What are the advantages of a Percutaneous Needle Fasciotomy?
2. No wounds - return to normal activities in 3 days
3. Does not prevent traditional surgery in the future
4. Can be repeated
What are the disadvantages of a Percutaneous Needle Fasciotomy?
1. Higher recurrence rates
2. Risk of Nerve injury