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Cates WT, Denbeigh JM, Salvagno RT, Kakar S, van Wijnen AJ, Eaton C. Inflammatory Markers Involved in the Pathogenesis of Dupuytren's Contracture. Crit Rev Eukaryot Gene Expr 2024; 34:1-35. [PMID: 38912961 DOI: 10.1615/critreveukaryotgeneexpr.2024052889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Dupuytren's disease is a common fibroproliferative disease that can result in debilitating hand deformities. Partial correction and return of deformity are common with surgical or clinical treatments at present. While current treatments are limited to local procedures for relatively late effects of the disease, the pathophysiology of this connective tissue disorder is associated with both local and systemic processes (e.g., fibrosis, inflammation). Hence, a better understanding of the systemic circulation of Dupuytren related cytokines and growth factors may provide important insights into disease progression. In addition, systemic biomarker analysis could yield new concepts for treatments of Dupuytren that attenuate circulatory factors (e.g., anti-inflammatory agents, neutralizing antibodies). Progress in the development of any disease modifying biologic treatment for Dupuytren has been hampered by the lack of clinically useful biomarkers. The characterization of nonsurgical Dupuytren biomarkers will permit disease staging from diagnostic and prognostic perspectives, as well as allows evaluation of biologic responses to treatment. Identification of such markers may transcend their use in Dupuytren treatment, because fibrotic biological processes fundamental to Dupuytren are relevant to fibrosis in many other connective tissues and organs with collagen-based tissue compartments. There is a wide range of potential Dupuytren biomarker categories that could be informative, including disease determinants linked to genetics, collagen metabolism, as well as immunity and inflammation (e.g., cytokines, chemokines). This narrative review provides a broad overview of previous studies and emphasizes the importance of inflammatory mediators as candidate circulating biomarkers for monitoring Dupuytren's disease.
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Affiliation(s)
- William T Cates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Janet M Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Andre J van Wijnen
- Department of Biochemistry, University of Vermont, Burlington, VT 05405, USA
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2
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Yamada H, Ikumi A, Yoshii Y, Yamazaki M. Isolated Distal Interphalangeal Joint Flexion Contracture of the Ring Finger due to Dupuytren Disease: A Case Report. J Hand Surg Asian Pac Vol 2023; 28:722-726. [PMID: 38073413 DOI: 10.1142/s2424835523720220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Dupuytren disease is a common benign fibromatosis of the palmar and finger fascia caused by pathological cord formation. As both the retrovascular and lateral cords are jointly responsible for the flexion contracture of the distal interphalangeal (DIP) joint, isolated DIP joint contracture caused by Dupuytren disease is rare. We present a 34-year-old right-hand-dominant male patient with a 6-month history of an isolated DIP joint flexion contracture in the right ring finger due to Dupuytren disease. Surgical fasciotomy of the retrovascular cord improved the contracture without adverse events. It is important to pay attention to the anatomical relationships between the pathological cord and neurovascular bundle to avoid neurovascular injury during fasciotomy in patients with Dupuytren disease, especially in isolated DIP joint contracture cases. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
| | | | - Yuichi Yoshii
- Tokyo Medical University, Ibaraki Medical Center, Ibaraki, Japan
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3
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Kwan SA, Tulipan JE, Hameed D, Matzon JL. Effect of Perioperative Corticosteroid Administration on Early Postoperative Range of Motion and Functional Outcomes Following Dupuytren's Fasciectomy. Hand (N Y) 2023; 18:925-930. [PMID: 35321575 PMCID: PMC10470228 DOI: 10.1177/15589447221084013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of the study was to evaluate whether perioperative corticosteroid (CS) administration improves early postoperative range of motion (ROM) and function in patients undergoing Dupuytren's fasciectomy. METHODS We retrospectively identified 58 patients who underwent Dupuytren's fasciectomy by a single fellowship-trained orthopedic hand surgeon from 2016 to 2020. During this time period, 51 digits in 34 patients received a single intraoperative dose of 10 mg of intravenous dexamethasone followed by a 6-day oral methylprednisolone taper course (CS group), and 37 digits in 24 patients did not (control group). Postoperatively, all patients started hand therapy within 1 week of surgery. At 2 and 6 weeks, patients had ROM data and Disabilities of the Arm, Shoulder, and Hand (DASH) scores collected by a blinded hand therapist. Paired t tests were used to compare the change in ROM and DASH scores at weeks 2 and 6. RESULTS The 2 cohorts had similar preoperative ROM. At 2 weeks postoperatively, the CS group had greater metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) flexion. There was no difference in MP, PIP, or DIP extension. At 6 weeks postoperatively, the CS group had greater PIP flexion. There was no difference between the groups in MP extension, MP flexion, PIP extension, DIP extension, or DIP flexion. Mean DASH scores were significantly lower in the CS group at weeks 2 and 6. There were no postoperative deep infections or complications requiring surgery in either group. CONCLUSION Perioperative CS administration appears to be safe and to improve early ROM and DASH scores following Dupuytren's fasciectomy.
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Affiliation(s)
| | - Jacob E. Tulipan
- Thomas Jefferson University and Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Daniel Hameed
- Thomas Jefferson University and Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonas L. Matzon
- Thomas Jefferson University and Rothman Orthopaedic Institute, Philadelphia, PA, USA
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4
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Putnam J. Advanced Dupuytren Contracture: Approach to Management. Hand Clin 2023; 39:455-463. [PMID: 37453772 DOI: 10.1016/j.hcl.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Dupuytren disease is a common pathologic condition that can be especially challenging to hand surgeons in recurrent or severe contractures. Recurrence risk may be reduced with a variety of techniques, including skin grafting, external fixator application, radiation, and many others described in this article. Management of recurrence requires special attention to anatomy at risk. Adjuvant therapy may help to prevent the progression or recurrence of severe disease.
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Affiliation(s)
- Jill Putnam
- The Hand and Upper Extremity Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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5
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Yuan S, Guo D, Liang X, Zhang L, Zhang Q, Xie D. Relaxin in fibrotic ligament diseases: Its regulatory role and mechanism. Front Cell Dev Biol 2023; 11:1131481. [PMID: 37123405 PMCID: PMC10134402 DOI: 10.3389/fcell.2023.1131481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/24/2023] [Indexed: 05/02/2023] Open
Abstract
Fibrotic ligament diseases (FLDs) are diseases caused by the pathological accumulation of periarticular fibrotic tissue, leading to functional disability around joint and poor life quality. Relaxin (RLX) has been reported to be involved in the development of fibrotic lung and liver diseases. Previous studies have shown that RLX can block pro-fibrotic process by reducing the excess extracellular matrix (ECM) formation and accelerating collagen degradation in vitro and in vivo. Recent studies have shown that RLX can attenuate connective tissue fibrosis by suppressing TGF-β/Smads signaling pathways to inhibit the activation of myofibroblasts. However, the specific roles and mechanisms of RLX in FLDs remain unclear. Therefore, in this review, we confirmed the protective effect of RLX in FLDs and summarized its mechanism including cells, key cytokines and signaling pathways involved. In this article, we outline the potential therapeutic role of RLX and look forward to the application of RLX in the clinical translation of FLDs.
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Affiliation(s)
- Shuai Yuan
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dong Guo
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xinzhi Liang
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Luhui Zhang
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Qun Zhang
- Good Clinical Practice Development, Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Denghui Xie, ; Qun Zhang,
| | - Denghui Xie
- Department of Joint Surgery and Sports Medicine, Center for Orthopedic Surgery, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Academy of Orthopedics, Guangdong Province, Guangzhou, Guangdong, China
- *Correspondence: Denghui Xie, ; Qun Zhang,
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6
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Puerta Cavanzo N, Riesmeijer SA, Holt-Kedde IL, Werker PMN, Piersma B, Olinga P, Bank RA. Verteporfin ameliorates fibrotic aspects of Dupuytren's disease nodular fibroblasts irrespective the activation state of the cells. Sci Rep 2022; 12:13940. [PMID: 35977978 PMCID: PMC9386017 DOI: 10.1038/s41598-022-18116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
Dupuytren’s disease is a chronic, progressive fibroproliferative condition of the hand fascia which results in digital contraction. So far, treatments do not directly interfere with the (myo)fibroblasts that are responsible for the formation of the collagen-rich cords and its contraction. Here we investigated whether verteporfin (VP) is able to inhibit the activation and subsequent differentiation of DD nodular fibroblasts into myofibroblasts. Fibroblasts were isolated from nodules of 7 Dupuytren patients. Cells are treated (1) for 48 h with 5 ng/ml transforming growth factor β1 (TGF-β1) followed by 48 h with/without 250 nM VP in the absence of TGF-β1, or treated (2) for 48 h with TGF-β1 followed by 48 h with/without VP in the presence of TGF-β1. mRNA levels were measured by means of Real-Time PCR, and proteins were visualized by means of Western blotting and/or immunofluorescence. Quantitative data were statistically analyzed with GraphPad Prism using the paired t-test. We found that fibroblasts activated for 48 h with TGF-β1 show a decrease in mRNA levels of COL1A1, COL3A1, COL4A1, PLOD2, FN1EDA, CCN2 and SERPINE1 when exposed for another 48 h with VP, whereas no decrease is seen for ACTA2, YAP1, SMAD2 and SMAD3 mRNA levels. Cells exposed for an additional 48 h with TGF-β1, but now in the presence of VP, are not further activated anymore, whereas in the absence of VP the cells continue to differentiate into myofibroblasts. Collagen type I, fibronectin-extra domain A, α-smooth muscle actin, YAP1, Smad2 and Smad3 protein levels were attenuated by both VP treatments. We conclude that VP has strong anti-fibrotic properties: it is able to halt the differentiation of fibroblasts into myofibroblasts, and is also able to reverse the activation status of fibroblasts. The decreased protein levels of YAP1, Smad2 and Smad3 in the presence of VP explain in part the strong anti-fibrotic properties of VP. Verteporfin is clinically used as a photosensitizer for photodynamic therapy to eliminate abnormal blood vessels in the eye to attenuate macular degeneration. The antifibrotic properties of VP do not rely on photo-activation, as we used the molecule in its non-photoinduced state.
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Affiliation(s)
- Nataly Puerta Cavanzo
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.,MATRIX Research Group, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Sophie A Riesmeijer
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Iris L Holt-Kedde
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Bram Piersma
- MATRIX Research Group, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Peter Olinga
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Ruud A Bank
- MATRIX Research Group, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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7
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Boe C, Blazar P, Iannuzzi N. Dupuytren Contractures: An Update of Recent Literature. J Hand Surg Am 2021; 46:896-906. [PMID: 34452797 DOI: 10.1016/j.jhsa.2021.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
Dupuytren disease is a fibroproliferative disorder that affects the palmar fascia of the hand and results in varying degrees of nodule and cord formation. Over time, patients may develop progressive contractures, impairing their ability to type, to perform with fine instruments, or to participate in social activities such as shaking hands. Treatment options for Dupuytren contractures include needle aponeurotomy (NA), injection of collagenase Clostridium histolyticum (CCH) with manipulation of the digits, and surgical fasciectomy. Over the past decade, the use of CCH has increased. Recent studies have provided additional data regarding the pathophysiology, indications, outcomes, and costs associated with the treatment for Dupuytren contractures, and this review highlights these advances.
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Affiliation(s)
- Chelsea Boe
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA
| | - Philip Blazar
- Section of Hand and Upper Extremity Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nicholas Iannuzzi
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA.
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8
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Current Concepts in the Management of Dupuytren Disease of the Hand. J Am Acad Orthop Surg 2021; 29:462-469. [PMID: 33651754 DOI: 10.5435/jaaos-d-20-00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/11/2021] [Indexed: 02/01/2023] Open
Abstract
Dupuytren disease is a fibroproliferative disorder of the palmar fascia of the hand. Little agreement and remarkable variability exists in treatment algorithms between surgeons. Because the cellular and molecular etiology of Dupuytren has been elucidated, ongoing efforts have been made to identify potential chemotherapeutic targets that could modulate the phenotypic expression of the disease. Although these efforts may dramatically alter the approach to treating this disease in the future, these approaches are largely experimental at this point. Over the past decade, the mainstay nonsurgical options have continued to be percutaneous needle aponeurotomy and collagenase Clostridium hystoliticum, and the most common surgical option is limited fasciectomy.
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9
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Ansari SA, Kennedy JA, Younis F. Skin Graft Review in Dermofasciectomy for Dupuytren’s Contracture within 48 Hours: Challenging Historical Practice. J Hand Microsurg 2021; 14:71-78. [DOI: 10.1055/s-0041-1726673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Early review of skin graft following dermofasciectomy with skin grafting for Dupuytren’s disease is not standard practice because of the potentially adverse effects on inosculation and neovascularization process of the skin grafting. The purpose of this retrospective case series was to observe whether early review of grafts postoperatively at 48 hours adversely affects graft survival and surgical outcomes.
Materials and Methods Forty-nine primary and revision procedures were retrospectively analyzed for treatment outcomes, postoperative complications, functional hand scoring, and satisfaction rates postoperatively.
Results Thirty-eight patients were treated successfully with no postoperative contracture. There were three treatment failures and two graft failures, with two amputations within these failures. Paired pre- and postoperative Unité Rhumatologique des Affections de la Main scoring demonstrated significant improvement in hand function for primary procedures, with a mean satisfaction score of 7.7 out of 10.
Conclusion We have shown early graft review following dermofasciectomy and full-thickness skin grafting to be safe, allowing early mobilization and splinting, with our postoperative failure and complication rate being within published literature.
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Affiliation(s)
- Saif Akhter Ansari
- Department of Hand Surgery, East Lancashire Hospitals National Health Service Trust, Lancashire, United Kingdom
| | - James Andrew Kennedy
- Health Education North West Trauma and Orthopaedics, Health Education North West, Lancashire, United Kingdom
| | - Fizan Younis
- Department of Hand Surgery, East Lancashire Hospitals National Health Service Trust, Lancashire, United Kingdom
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10
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Ito Y, Naito K, Nagura N, Sugiyama Y, Obata H, Kaneko A, Goto K, Kaneko K, Ishijima M. Finger shortening for Dupuytren's disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases. SICOT J 2021; 7:11. [PMID: 33683196 PMCID: PMC7938730 DOI: 10.1051/sicotj/2021005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022] Open
Abstract
When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren’s disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren’s disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.
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Affiliation(s)
- Yoko Ito
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Ayaka Kaneko
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
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11
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Ferrara PE, Codazza S, Cerulli S, Maccauro G, Ferriero G, Ronconi G. Physical modalities for the conservative treatment of wrist and hand's tenosynovitis: A systematic review. Semin Arthritis Rheum 2020; 50:1280-1290. [DOI: 10.1016/j.semarthrit.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/10/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022]
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12
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Isolated Small Finger Distal Interphalangeal Joint Dupuytren's Contracture. Case Rep Orthop 2019; 2019:7183739. [PMID: 31781455 PMCID: PMC6875190 DOI: 10.1155/2019/7183739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/24/2019] [Accepted: 09/17/2019] [Indexed: 11/21/2022] Open
Abstract
Dupuytren's contracture is a disease involving abnormal myofibroblast proliferation and collagen deposition leading to the formation of pathologic cords in the hand. Given that Dupuytren's contractures rarely extend to the distal interphalangeal joint (DIP), affecting only 5% of patients, there are few cases reported in the literature. Collagenase injection is a frequently used option for minimally invasive treatment of Dupuytren's disease with greater than a 20-degree joint contracture. Unfortunately, there is limited research on the effectiveness of these injections in isolated DIP joint deformities. We present a case of a 61-year-old right hand-dominant male with a 2-year history of isolated right small finger Dupuytren's contracture at the DIP joint who achieved significant improvement after collagenase injection.
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Using Tongue Depressors as a Technique to Aid Cord Localization During Collagenase Injection For Dupuytren Disease. Tech Hand Up Extrem Surg 2019; 23:196-198. [PMID: 31738740 DOI: 10.1097/bth.0000000000000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Collagenase injections are used as a minimally invasive treatment for Dupuytren contracture of the palm and fingers, with good published success. Most complications are related to injection-site swelling, pain, and ecchymosis. However, the risk of flexor tendon and digital nerve injury can occur when injecting cords that cause proximal interphalangeal joint contractures. In addition, poor localization and incorrect injection of the solution into cords may result in an incomplete correction. We describe a technique to improve visualization and isolation of Dupuytren cords using a tongue depressor.
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14
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Bergovec M, Jelicic J, Oljaca A, Bilic R. Hand function and recurrence after limited fasciectomy for Dupuytren's contracture: Long-term follow-up. J Orthop Surg (Hong Kong) 2019. [PMID: 29529955 DOI: 10.1177/2309499018762195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to analyze long-term results after limited fasciectomy for Dupuytren's contracture. METHODS The study included 34 patients (52 rays), with an average follow-up of 9.5 years (range: 7-13 years). Range of motion, functional status, recurrence, and complications were recorded. RESULTS Preoperative metacarpophalangeal joint (MCPJ) contracture (median: 35°, range: 0-90°) improved postoperatively to full extension in all but one patient, with no recurrence at the most recent follow-up. Preoperative proximal interphalangeal joint (PIPJ) contractures (median: 52°, range: 5-100°) were initially corrected, but recurred with time (median: 25°, range 0°-80°). Hand function was assessed using the Disabilities of the Arm, Shoulder and Hand questionnaire. Postoperative hand function improved (median: 0, range: 0-27), compared to preoperative function (median: 20, range: 0-51). Hand function worsened with time (at most recent follow-up: median: 3, range: 0-40), mainly due to PIPJ contracture recurrence, but function remained better than before surgery. CONCLUSION Limited fasciectomy is an effective treatment method for MCPJ, with full correction achievable in both the short and long term. Regarding the PIPJ, treatment outcomes seem to be multifactorial. Further clarification is required to distinguish between local recurrence and remaining contracture of the PIPJ.
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Affiliation(s)
- Marko Bergovec
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia.,2 Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Josko Jelicic
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Oljaca
- 2 Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Ranko Bilic
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
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15
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Aglen T, Matre KH, Lind C, Selles RW, Aßmus J, Taule T. Hand therapy or not following collagenase treatment for Dupuytren's contracture? Protocol for a randomised controlled trial. BMC Musculoskelet Disord 2019; 20:387. [PMID: 31455312 PMCID: PMC6712875 DOI: 10.1186/s12891-019-2712-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background Dupuytren’s contracture (DC) is a fibrotic hand condition in which one or more fingers develop progressive flexion deformities. Quality of life is diminished due to disabling limitations in performing everyday activities. For DC patients treated with collagenase, referral for subsequent hand therapy is inconsistent. It is unknown whether subsequent hand therapy is beneficial compared to no therapy. The purpose of this study is to determine whether hand therapy improves DC patients’ performance of and satisfaction with performing everyday activities one year after collagenase treatment. Methods We will conduct a randomised controlled trial with two treatment groups (hand therapy vs. control) of DC patients who have received collagenase treatment. DC patients with contracted metacarpophalangeal joint(s) (MCPJ) (hand therapy, n = 40; control, n = 40) and those with proximal interphalangeal joint(s) (PIPJ) involvement (hand therapy, n = 40; control, n = 40) comprise two subgroups, and we will study if the treatment effect will be different between both groups (n = 160). Patients with a previous injury or treatment for DC in the treatment finger are excluded. Hand therapy includes oedema and scar management, splinting, movement exercises, and practice of everyday activities. The main outcome variable is patients’ performance of and satisfaction with performing everyday activities, as assessed with the Canadian Occupational Performance Measure. Secondary outcomes are DC-specific activity problems, as assessed with the Unité Rhumatologique des Affections de la Main scale, and active/passive flexion/extension of treated joints and grip force using standard measuring tools, and self-reported pain level. Demographic and clinical variables, degree of scarring, cold hypersensitivity, number of occupational sick-leave days are collected. Self-reported global impression of change will be used to assess patient satisfaction with change in hand function. Assessments are done pre-injection and 6 weeks, 4 months, and 1 year later. Standard univariate and multivariate statistical analyses will be used to evaluate group differences. Discussion This study aims to assess whether hand therapy is beneficial for activity-related, biomechanical, and clinical outcomes in DC patients after collagenase treatment. The results will provide an objective basis for determining whether hand therapy should be conducted after collagenase treatment. Trial registration This study has been registered at ClinicalTrials.gov as NCT03580213 (April 5, 2018).
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Affiliation(s)
- Terese Aglen
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway.
| | - Karin Hoegh Matre
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway
| | - Cecilie Lind
- Department for Plastic-, Hand-, Reconstructive surgery and National burn unit, Surgery Clinic, Haukeland University Hospital (HUH), Bergen, Norway
| | - Ruud W Selles
- Department of Rehabilitation Medicine and department of Plastic and Reconstructive Surgery Hand Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Jörg Aßmus
- Centre for Clinical Research, HUH, Bergen, Norway
| | - Tina Taule
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway
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Dhawan V, Yonz C, Zhang X, Shao X, Du W. Using tongue depressors to aid cord localization during collagenase injection for Dupuytren disease. HAND SURGERY & REHABILITATION 2019; 38:290-292. [PMID: 31382027 DOI: 10.1016/j.hansur.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/04/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
The aim of this paper was to introduce a simple and effective method to aid in isolation and stabilization of Dupuytren cords for collagenase injection. Tongue depressors were used to isolate and stabilize the cord during the injection procedure. The area to be injected was sterilely prepared. An assistant was then directed to place a tongue depressor on both sides of the cord. A total of 35 patients with Dupuytren disease were treated. Follow-up lasted two years. Post-operative Disabilities of the Arm, Shoulder and Hand (DASH) scores was 4±2. Health-related quality of life measured with the EQ-5D index was 0.89±0.4. Recurrence rates of metacarpophalangeal joint and proximal interphalangeal joint were 11% and 14% respectively, using a flexion contracture of 20° to define recurrence. Collagenase treatment using a modified injection method with the aid of tongue depressors are a safe, effective way to treat Dupuytren contractures of the fingers. The technique can isolate the cord, which improves visualization of the cord. It may allow improved accuracy with needle placement and helps to decrease the complications and recurrence.
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Affiliation(s)
- V Dhawan
- Department of Orthopedics and Sports Medicine, Hand and Upper Extremity Service, University of Kentucky, 740 S Limestone, Suite K 401, Lexington, KY 40506, USA
| | - C Yonz
- Department of Orthopedics and Sports Medicine, Hand and Upper Extremity Service, University of Kentucky, 740 S Limestone, Suite K 401, Lexington, KY 40506, USA
| | - X Zhang
- Department of hand surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang, Hebei, 050051, China.
| | - X Shao
- Department of hand surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang, Hebei, 050051, China
| | - W Du
- Department of hand surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang, Hebei, 050051, China
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Jung J, Kim GW, Lee B, Joo JWJ, Jang W. Integrative genomic and transcriptomic analysis of genetic markers in Dupuytren's disease. BMC Med Genomics 2019; 12:98. [PMID: 31296227 PMCID: PMC6624179 DOI: 10.1186/s12920-019-0518-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Dupuytren’s disease (DD) is a fibroproliferative disorder characterized by thickening and contracting palmar fascia. The exact pathogenesis of DD remains unknown. Results In this study, we identified co-expressed gene set (DD signature) consisting of 753 genes via weighted gene co-expression network analysis. To confirm the robustness of DD signature, module enrichment analysis and meta-analysis were performed. Moreover, this signature effectively classified DD disease samples. The DD signature were significantly enriched in unfolded protein response (UPR) related to endoplasmic reticulum (ER) stress. Next, we conducted multiple-phenotype regression analysis to identify trans-regulatory hotspots regulating expression levels of DD signature using Genotype-Tissue Expression data. Finally, 10 trans-regulatory hotspots and 16 eGenes genes that are significantly associated with at least one cis-eQTL were identified. Conclusions Among these eGenes, major histocompatibility complex class II genes and ZFP57 zinc finger protein were closely related to ER stress and UPR, suggesting that these genetic markers might be potential therapeutic targets for DD. Electronic supplementary material The online version of this article (10.1186/s12920-019-0518-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junghyun Jung
- Department of Life science, Dongguk University-Seoul, Seoul, 04620, Republic of Korea
| | - Go Woon Kim
- Department of Pharmacology, College of Pharmacy, Kyung Hee University, 26 Kyungheedae-ro, Seoul, 02447, South Korea
| | - Byungjo Lee
- Department of Life science, Dongguk University-Seoul, Seoul, 04620, Republic of Korea
| | - Jong Wha J Joo
- Department of Computer Science and Engineering, Dongguk University-Seoul, Seoul, 04620, South Korea.
| | - Wonhee Jang
- Department of Life science, Dongguk University-Seoul, Seoul, 04620, Republic of Korea.
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18
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Hellwinkel JE, Khodaee M. Hand contracture in an elderly male. Geriatr Gerontol Int 2018; 18:1653-1654. [DOI: 10.1111/ggi.13564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Justin E Hellwinkel
- Department of Family MedicineUniversity of Colorado School of Medicine Denver Colorado USA
| | - Morteza Khodaee
- Department of Family MedicineUniversity of Colorado School of Medicine Denver Colorado USA
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3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren's surgery. Arch Plast Surg 2018; 45:557-563. [PMID: 30466236 PMCID: PMC6258978 DOI: 10.5999/aps.2016.02131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 10/02/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Numerous Dupuytren's fasciectomy techniques have been described, each associated with unique surgical challenges, complications and recurrence rates. We describe a common ground surgical approach to Dupuytren's disease; 3-dimensional fasciectomy (3DF). 3DF aims to address the potential contributors to the high recurrence rate of Dupuytren's disease and unite current limited fasciectomy practice that varies considerably between surgeons. METHODS We describe the 3DF principles; raising thin skin flaps (addressing dermal involvement), excising diseased palmar fascia with a 3-5 mm clearance margin (treating highly locally recurrent conditions) and excising the vertical septae of Legueu and Juvara (providing deep clearance, hence addressing all potentially involved pathological tissue). The surgical outcomes between traditional limited fasciectomy (LF) and 3DF are compared. RESULTS From the 786 operations included (n=585), postoperative recurrence rates were significantly lower for the 3DF group (2/145, 1.4%) than the LF group (72/641, 11.2%) (P=0.001), and the time to recurrence was significantly longer (5.0±0 years vs. 4.0±0.2 years; P<0.0001). With recurrence excluded, there were no differences between the postoperative complication rates for 3DF (5/145, 3.5%) and LF (41/641, 6.4%) (P=0.4). CONCLUSIONS Our results suggest that 3DF leads to lower recurrence rates and a longer disease-free period for patients, without increasing complications. 3DF provides a safe, efficacious, common ground surgical approach in the treatment of Dupuytren's flexion deformity.
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Mansur HG, Oliveira ERD, Gonçalves CB. Análise epidemiológica dos pacientes com doença de Dupuytren. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2016.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Epidemiological analysis of patients with Dupuytren's disease. Rev Bras Ortop 2017; 53:10-14. [PMID: 29367900 PMCID: PMC5771785 DOI: 10.1016/j.rboe.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the risk factors and analyze the characteristics of patients and lesions in Dupuytren's disease. Methods Retrospective analysis of patients diagnosed with Dupuytren's disease in a hand surgery clinic in 2013. The authors evaluated parameters associated with the patient profiles and risk factors, the form and severity of involvement, and characteristics of the lesions. Results 58 patients were evaluated, totaling 79 hands, with bilateral involvement in 46% of cases. The involvement of the ulnar fingers of the hand represented 78%, 44% being the ring finger. In 55% of cases, the patients had cords, while 45% showed only nodules. As for related factors, they were found most commonly in men (55%), whites (93%), and the elderly. Of coexisting diseases, the following were present: diabetes mellitus (49%), especially in the insulin-dependent (62%), hypertension (55.2%), and dyslipidemia (19%). With regard to lifestyle, 22% were smokers and 9% were alcohol consumers. Conclusion It was observed a higher incidence of Dupuytren's disease was observed among men, whites, and the ulnar fingers of the hand, especially the ring finger. The most common associated diseases were diabetes mellitus and hypertension.
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Evidence-Based Medicine: Options for Dupuytren's Contracture: Incise, Excise, and Dissolve. Plast Reconstr Surg 2017; 139:240e-255e. [PMID: 28027258 DOI: 10.1097/prs.0000000000002857] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand updates in the basic science, epidemiology, and treatment of Dupuytren's disease. 2. Understand treatment with needle aponeurotomy, collagenase, and fasciectomy. 3. Understand advanced needle techniques for Dupuytren's contracture. 4. Understand the safety and effectiveness of a new treatment, collagenase. SUMMARY The literature on Dupuytren's disease encompasses many specialties. Its treatment is generally by perforating, excising, or dissolving the affected tissues. This article reviews the changing understanding of this disease and treatment options.
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Bear BJ, Peimer CA, Kaplan FTD, Kaufman GJ, Tursi JP, Smith T. Treatment of Recurrent Dupuytren Contracture in Joints Previously Effectively Treated With Collagenase Clostridium histolyticum. J Hand Surg Am 2017; 42:391.e1-391.e8. [PMID: 28341067 DOI: 10.1016/j.jhsa.2017.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 01/30/2017] [Accepted: 02/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Collagenase Clostridium histolyticum (CCH) is approved for the treatment of adults with Dupuytren contracture with a palpable cord. This open-label, phase 4 study evaluated the safety and efficacy of CCH for the retreatment of recurrent contractures in joints that were previously effectively treated with CCH. METHODS Patients participating in a long-term follow-up study who had contracture recurrence (increased ≥ 20° with a palpable cord) after successful treatment in the previous study were eligible. Recurrent joint contractures were treated with up to 3 CCH injections (∼ 1 month apart). Patients were followed for 1 year to evaluate safety. Assessments included change in joint contracture, range of motion, and the percentage of joints that achieved contracture of 5° or less at day 30 after the last injection. RESULTS The efficacy analysis included 51 patients with 1 treated joint per patient (31 metacarpophalangeal, 20 proximal interphalangeal). A total of 35 joints (69%) received 1 injection, 12 (24%) received 2 injections, and 4 (8%) received 3 injections. Fifty-seven percent of joints achieved contracture of 5° or less (29 of 51). Overall, 86% (43 of 50) patients had a 20° or greater increase in range of motion. The adverse event profile was consistent with previous studies. One ligament injury was reported. CONCLUSIONS At a short-term follow-up of 1 year, recurrent contracture in joints previously successfully treated with CCH may be effectively retreated with up to 3 injections of CCH. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Clayton A Peimer
- College of Human Medicine, Michigan State University, East Lansing; and the UP Health System-Marquette, Hand Surgery Office, Marquette, MI
| | | | | | | | - Ted Smith
- Endo Pharmaceuticals Inc., Malvern, PA
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Warwick D, Arandes-Renú JM, Pajardi G, Witthaut J, Hurst LC. Collagenase Clostridium histolyticum: emerging practice patterns and treatment advances. J Plast Surg Hand Surg 2016; 50:251-61. [PMID: 27050718 PMCID: PMC5044771 DOI: 10.3109/2000656x.2016.1159568] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/13/2015] [Accepted: 01/24/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study aims to provide a comprehensive review of the role of Collagenase Clostridium histolyticum (CCH). METHODS This review is based on a literature review and practical experience. RESULTS This review provides practical management strategies for using collagenase by sharing clinical experiences over the past few years; logistical aspects of in-clinic treatment, lessons learned, and novel approaches to correct traditionally hard-to-treat contractures are discussed. In addition a brief, yet comprehensive overview is provided on the pathophysiology of the disease, the mechanism of collagenase action and results of clinical studies. CONCLUSION CCH has an evolving role as one of the tools available for treating Dupuytren's disease.
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Affiliation(s)
- David Warwick
- The Hand Clinic, University Hospital Southampton,
Hampshire,
UK
| | - José M. Arandes-Renú
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Mano, Hospital Clínic,
Barcelona,
SpainUniversidad de Barcelona
| | - Giorgio Pajardi
- Department of Hand Surgery, San Giuseppe MultiMedica University Hospital, Milan and Università degli Studi di,
Milano,
Italy
| | - Jörg Witthaut
- Hand Surgery, Schön Klinik Vogtareuth,
Vogtareuth,
Germany
| | - Lawrence C. Hurst
- Department of Orthopaedics, Stony Brook School of Medicine,
Stony Brook,
NY,
USA
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25
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Crivello KM, Potter HG, Moon ES, Rancy SK, Wolfe SW. Does collagenase injection disrupt or digest the Dupuytren's cord: a magnetic resonance imaging study. J Hand Surg Eur Vol 2016; 41:614-20. [PMID: 26768221 DOI: 10.1177/1753193415626113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/01/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Collagenase clostridium histolyticum has been extensively studied as a treatment modality for Dupuytren's contracture. Its mechanism of action has been documented. It is unknown whether injected collagenase weakens the Dupuytren's cord sufficiently to cause failure during manipulation or if there is digestion and reduction in cord volume. We examined five patients with isolated contractures of the ring or middle metacarpalphalangeal (MP) joint using magnetic resonance imaging (MRI) prior to injection with collagenase and again 1 month following injection. All patients had full correction after manipulation which was maintained at follow-up. The Dupuytren's cord was evaluated with respect to volume, signal intensity, inflammatory changes and continuity. Additionally, signal intensity changes of the flexor tendons and neurovascular structures were recorded. MRI demonstrated cord discontinuity, significant reduction of cord volume and a significant increase in cord signal intensity after treatment with collagenase. There was a slight increase in flexor tendon signal intensity that was not significant. These findings suggest that there may be local chemical dissolution of the cord. Future studies may establish whether or not this will have prognostic implications in terms of correction and recurrence following collagenase injection. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- K M Crivello
- Mercer Bucks Orthopaedics, Lawrenceville, NJ, USA
| | - H G Potter
- The Hospital for Special Surgery, New York, NY, USA
| | - E S Moon
- Mt. Tam Orthopedics and Sports Medicine, Larkspur, CA, USA
| | - S K Rancy
- The Hospital for Special Surgery, New York, USA
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Gaston RG, Larsen SE, Pess GM, Coleman S, Dean B, Cohen BM, Kaufman GJ, Tursi JP, Hurst LC. The Efficacy and Safety of Concurrent Collagenase Clostridium Histolyticum Injections for 2 Dupuytren Contractures in the Same Hand: A Prospective, Multicenter Study. J Hand Surg Am 2015. [PMID: 26216077 DOI: 10.1016/j.jhsa.2015.06.099] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate efficacy and safety of concurrent administration of 2 collagenase clostridium histolyticum (CCH) injections to treat 2 joints in the same hand with Dupuytren fixed flexion contractures (FFCs). METHODS Patients with 2 or more contractures in the same hand caused by palpable cords participated in a 60-day, multicenter, open-label, phase 3b study. Two 0.58 mg CCH doses were injected into 1 or 2 cords in the same hand (1 injection per affected joint) during the same visit. Finger extension was performed approximately 24, 48, or 72 or more hours later. Changes in FFC and range of motion, incidence of clinical success (FFC ≤ 5°), and adverse events (AEs) were summarized. RESULTS The study enrolled 715 patients (725 treated joint pairs), and 714 patients (724 joint pairs) were analyzed for efficacy. At day 31, mean total FFC (sum of 2 treated joints) decreased 74%, from 98° to 27°. Mean total range of motion increased from 90° to 156°. The incidence of clinical success was 65% in metacarpophalangeal joints and 29% in proximal interphalangeal joints. Most treatment-related AEs were mild to moderate, resolving without intervention; the most common were swelling of treated extremity, contusion, and pain in extremity. The incidence of skin lacerations was 22% (160 of 715). Efficacy and safety were similar regardless of time to finger extension. CONCLUSIONS Collagenase clostridium histolyticum can be used to effectively treat 2 affected joints concurrently without a greater risk of AEs than treatment of a single joint, with the exception of skin laceration. The incidence of clinical success in this study after 1 injection per joint was comparable to phase 3 study results after 3 or more injections per joint. Two concurrent CCH injections may allow more rapid overall treatment of multiple affected joints, and the ability to vary the time between CCH injection and finger extension may allow physicians and patients greater flexibility with scheduling treatment.
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Affiliation(s)
| | - Søren Erik Larsen
- Unit for Hand Surgery, Department of Orthopaedics, Odense University Hospital, Odense, Denmark
| | | | - Stephen Coleman
- Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia
| | - Brian Dean
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA
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Kaplan FTD, Badalamente MA, Hurst LC, Merrell GA, Pahk R. Delayed manipulation after collagenase clostridium histolyticum injection for Dupuytren contracture. Hand (N Y) 2015; 10:578-82. [PMID: 26330801 PMCID: PMC4551642 DOI: 10.1007/s11552-014-9714-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture was approved in the USA in 2010. Current FDA guidelines stipulate that finger manipulation occurs the day following injection. To investigate the safety and efficacy of delaying manipulation to 2 or 4 days following CCH injection, we conducted a prospective, randomized trial at two sites. METHODS Patients with Dupuytren contracture involving the metacarpophalangeal (MCP) joint ≥20° caused by a palpable cord participated. All patients received one dose of CCH (0.58 mg/0.25 ml) and were followed for 90 days. The primary end point was the percent of patients maintaining clinical success (reduction of contracture to 0°-5°) at 90 days post-injection. Adverse events and change in Michigan Hand Questionnaire (MHQ) score were recorded as secondary end points. RESULTS Thirty-seven patients enrolled; 13 were manipulated on day 1, 11 on day 2, and 13 on day 4. At 30 days after injection, the percentage of patients obtaining reduction of contracture to <0°-5° extension was 92, 82, and 85 % in groups 1, 2, and 3, respectively, with no significant difference. At 90 days follow-up, the percentage of patients maintaining 0°-5° extension was 91, 82, and 83 % in groups 1, 2, and 3, respectively, with no significant difference. Adverse events were comparable to rates in prior studies. There were no serious adverse events. There was no statistical difference in MHQ scores between groups at any time point. CONCLUSIONS Delaying manipulation to day 2 or 4 following CCH injection for MCP joint contractures does not increase adverse events or result in loss of efficacy. LEVEL OF EVIDENCE Therapeutic, Level II.
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Affiliation(s)
- F. Thomas D. Kaplan
- />Indiana Hand to Shoulder Center, 8501 Harcourt Rd, Indianapolis, IN 46260 USA
| | - Marie A. Badalamente
- />Department of Orthopaedics, Stony Brook University Medical Center, Stony Brook, NY USA
| | - Lawrence C. Hurst
- />Department of Orthopaedics, Stony Brook University Medical Center, Stony Brook, NY USA
| | - Gregory A. Merrell
- />Indiana Hand to Shoulder Center, 8501 Harcourt Rd, Indianapolis, IN 46260 USA
| | - Raymond Pahk
- />Department of Orthopaedics, Stony Brook University Medical Center, Stony Brook, NY USA
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Musumeci M, Vadalà G, Russo F, Pelacchi F, Lanotte A, Denaro V. Dupuytren's disease therapy: targeting the vicious cycle of myofibroblasts? Expert Opin Ther Targets 2015; 19:1677-87. [PMID: 26690790 DOI: 10.1517/14728222.2015.1068758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Dupuytren's disease (DD) is a proliferative fibromatosis of the hand, which causes permanent flexion contracture of the digits and, ultimately, loss of function. The treatment of DD is complex and involves surgical and nonsurgical approaches, with the goal of removing the affected tissue. New biological targets are under investigation in order to develop innovative therapies. AREAS COVERED The etiology of DD is still unknown. Several authors who focused their studies on the genetics of DD recognized an inherited autosomal dominant pattern. Actually, DD is a multifactorial and complex disease. Myofibroblasts are thought to play a crucial role in its pathogenesis, although their origin is not clear. EXPERT OPINION There is a general consensus that a better understanding of cellular and molecular mechanisms of DD will lead to the design of more specific and effective treatment alternatives. In this review, the authors hypothesize a new biological model for DD pathology, where myofibroblasts enhance the reservoir of the disease acting as if in a vicious cycle. This could help, ultimately, in identifying new therapeutic strategies to treat this common and disabling fibroproliferative disorder.
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Affiliation(s)
- Maria Musumeci
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Gianluca Vadalà
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ; .,b 2 Cell Factory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Fabrizio Russo
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Federica Pelacchi
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Angela Lanotte
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
| | - Vincenzo Denaro
- a 1 Campus Bio-Medico University of Rome, Department of Orthopaedic and Trauma Surgery , Via Alvaro del Portillo 200, 00128 Rome, Italy +39 06 2254111192 ; +39 06 225411638 ;
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Nunn AC, Schreuder FB. Dupuytren's contracture: emerging insight into a Viking disease. ACTA ACUST UNITED AC 2015; 19:481-90. [PMID: 25288296 DOI: 10.1142/s0218810414300058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dupuytren's disease is a fibroproliferative condition of the palm, with a predilection for men, which has affected Northern Europeans since the Viking conquests. Although strongly heritable, clear evidence exists for environmental factors that modify the underlying genetic risk, such as diabetes, heavy drinking, and smoking. Evidence also exists for epilepsy (probably due to treatment with certain anti-epileptic drugs), and Human Immunodeficiency Virus infection. Recent large studies have shown no relationship with manual labour or vibrating tools. Two theories have emerged regarding the pathogenic mechanism: the first attributes the aberrant healing process that characterises Dupuytren's to free radicals, generated as a result of microangiopathy, whereas the second cites a genetic tendency toward apoptosis-resistant myofibroblasts. Despite only one study demonstrating linkage, emerging data from genome-wide association studies highlight a series of single nucleotide polymorphisms near members of the Wnt signalling pathway, and transcriptional profiling studies have consistently identified certain components of the extracellular matrix.
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Affiliation(s)
- Adam C Nunn
- Department of Older People's Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
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Diep GK, Agel J, Adams JE. Prevalence of palmar fibromatosis with and without contracture in asymptomatic patients. J Plast Surg Hand Surg 2015; 49:247-50. [PMID: 25854281 DOI: 10.3109/2000656x.2015.1034724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This retrospective study documents the proportion of hand clinic patients presenting with palmar fibromatosis with and without contracture. METHODS All "new" patients >18 years presenting to a single surgeon's hand clinic over a 16-month period were included, and information was abstracted from chart review regarding patient demographics, reason for presentation, presence or absence of palmar fibromatosis, contracture, and prior known diagnosis of Dupuytren's disease. The percentage of asymptomatic patients with palmar fibromatosis was calculated. RESULTS Of 827 patients, 306 had palmar fibromatosis. Among all patients, 33% of male and 40% of female patients had palmar fibromatosis. Only 8% had contractures, while 92% had palmar fibromatosis without contracture. Among those who had contractures, 81% presented with a primary complaint of Dupuytren's disease (symptomatic contracture). Prevalence of palmar fibromatosis increased with increasing age. CONCLUSION The findings demonstrate that Dupuytren's palmar fibromatosis is common and often present without overt contractures.
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Affiliation(s)
- Gustave K Diep
- University of Minnesota Medical School , Minneapolis, MN , USA
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Anderson ER, Ye Z, Caldwell MD, Burmester JK. SNPs previously associated with Dupuytren's disease replicated in a North American cohort. Clin Med Res 2014; 12:133-7. [PMID: 24573701 PMCID: PMC4317152 DOI: 10.3121/cmr.2013.1199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Dupuytren's disease is a progressive fibrosis of the hand that often results in debilitating flexion contractures. Its etiology is not completely understood but likely involves both genetic and environmental factors. A recent study performed in Europe identified DNA variants that associate with Dupuytren's disease. Given the likelihood for genetic variation among populations, we planned to validate the genetic variants identified by this study in a North American population. METHODS In the Marshfield Clinic's Personalized Medicine Research Project, 296 cases with Dupuytren's disease were identified and matched 3-to-1 to controls without Dupuytren's disease. Clinical data were abstracted from the electronic medical record. The top 12 single nucleotide polymorphisms (SNPs) from the European study were selected and tested in a multiplex assay using the MassArray Analyzer 4 (Sequenom, Inc., San Diego, CA). Differences in allele frequency were determined, and variants with a P value of <0.004 were considered significant. RESULTS We replicated 5 of the 12 SNPs previously reported to be associated with Dupuytren's disease. CONCLUSION Our findings support a role for the Wnt signaling pathway in the development of Dupuytren's disease, and suggest that further study of this pathway may result in early diagnosis and non-surgical treatments for Dupuytren's disease.
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Affiliation(s)
| | - Zhan Ye
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Michael D Caldwell
- Department of General Surgery, Director of Wound Healing Program, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - James K Burmester
- Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
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Identification of histological patterns in clinically affected and unaffected palm regions in dupuytren's disease. PLoS One 2014; 9:e112457. [PMID: 25379672 PMCID: PMC4224499 DOI: 10.1371/journal.pone.0112457] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022] Open
Abstract
Dupuytren's disease is a fibro-proliferative disease characterized by a disorder of the extracellular matrix (ECM) and high myofibroblast proliferation. However, studies failed to determine if the whole palm fascia is affected by the disease. The objective of this study was to analyze several components of the extracellular matrix of three types of tissues—Dupuytren's diseased contracture cords (DDC), palmar fascia clinically unaffected by Dupuytren's disease contracture (NPF), and normal forehand fascia (NFF). Histological analysis, quantification of cells recultured from each type of tissue, mRNA microarrays and immunohistochemistry for smooth muscle actin (SMA), fibrillar ECM components and non-fibrillar ECM components were carried out. The results showed that DDC samples had abundant fibrosis with reticular fibers and few elastic fibers, high cell proliferation and myofibroblasts, laminin and glycoproteins, whereas NFF did not show any of these findings. Interestingly, NPF tissues had more cells showing myofibroblasts differentiation and more collagen and reticular fibers, laminin and glycoproteins than NFF, although at lower level than DDC, with similar elastic fibers than DDC. Immunohistochemical expression of decorin was high in DDC, whereas versican was highly expressed NFF, with no differences for aggrecan. Cluster analysis revealed that the global expression profile of NPF was very similar to DDC, and reculturing methods showed that cells corresponding to DDC tissues proliferated more actively than NPF, and NPF more actively than NFF. All these results suggest that NPF tissues may be affected, and that a modification of the therapeutic approach used for the treatment of Dupuytren's disease should be considered.
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Gajendran VK, Hentz V, Kenney D, Curtin CM. Multiple collagenase injections are safe for treatment of Dupuytren's contractures. Orthopedics 2014; 37:e657-60. [PMID: 24992063 DOI: 10.3928/01477447-20140626-64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 12/27/2013] [Indexed: 02/03/2023]
Abstract
The authors report the case of a 65-year-old, right-hand-dominant man who had severe Dupuytren's disease with multiple cords and flexion contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated collagenase injections for treatment. Collagenase has been shown to be safe and effective in the treatment of Dupuytren's contractures when administered as a single dose, but the results of multiple injections over a prolonged period are unknown. Antibodies to collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The antibodies generated as a result of repeated exposure to collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as anaphylaxis. The authors present the case of a single patient who experienced continued correction of his contractures with only minor and self-limited adverse reactions after administration of 12 collagenase doses through 15 injections during a 4-year period. Over time, the injections continued to be effective at correcting metacarpophalangeal joint contractures, but less effective at correcting proximal interphalangeal joint contractures. The patient did eventually require a fasciectomy, but the safety and modest success of the repeated collagenase injections shows promise for a less invasive treatment with a better risk profile than open fasciectomy. Although further studies are needed, repeated administration of collagenase appears to be safe and modestly effective for severe Dupuytren's contractures, although a fasciectomy may ultimately be required in the most severe cases.
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Steinberg JP, Gurjala AN, Jia S, Hong SJ, Galiano RD, Mustoe TA. Evaluating the Effects of Subclinical, Cyclic Ischemia-Reperfusion Injury on Wound Healing Using a Novel Device in the Rabbit Ear. Ann Plast Surg 2014; 72:698-705. [DOI: 10.1097/sap.0b013e31826a1ae2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kang YM, Choi YR, Yun CO, Park JO, Suk KS, Kim HS, Park MS, Lee BH, Lee HM, Moon SH. Down-regulation of collagen synthesis and matrix metalloproteinase expression in myofibroblasts from Dupuytren nodule using adenovirus-mediated relaxin gene therapy. J Orthop Res 2014; 32:515-23. [PMID: 24293067 DOI: 10.1002/jor.22535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 11/09/2013] [Indexed: 02/04/2023]
Abstract
Dupuytren's disease is a fibroproliferative connective tissue disorder characterized by contracture of the palmer fascia of the hand. Relaxin (RLN) is a multifunctional factor which contributes to the remodeling of the pelvic ligament by inhibiting fibrosis and inflammatory activities. The aim of this study was to investigate the effect of the RLN gene on the inhibition of fibrosis in myofibroblastic cells. Myofibroblast cells with adenovirus LacZ (Ad-LacZ) as a marker gene or adenovirus relaxin (Ad-RLN) as therapeutic gene showed transgene expressions in beta-galactosidase assay and Western blot analysis. Myofibroblastic cells with Ad-RLN demonstrated a 22% and 48% reduction in collagen I and III mRNA expressions respectively, a 50% decrease in MMP-1, 70% decrease in MMP-2, 80% decrease in MMP-9, and a 15% reduction in MMP-13 protein expression compared with cultures with viral control and saline control. In addition, myofibroblastic cells with Ad-RLN showed a 40% decrease in TIMP 1 and a 15% increase in TIMP 3 protein expression at 48 h compared to cultures with viral control and saline control. Also, myofibroblastic cell with Ad-RLN demonstrated a 74% inhibition of fibronectin and a 52% decrease in total collagen synthesis at 48 h compared with cultures with viral control and saline control. In conclusion, the RLN gene render antifibrogenic effect on myofibroblastic cells from Dupuytren's nodule via direct inhibition of collagen synthesis not through collagenolytic pathway such as MMP-1, -13, TIMP 1, and 3. Therefore relaxin can be an alternative therapeutic strategy in initial stage of Dupuytren's disease by its antifibrogenic effect.
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Affiliation(s)
- Young-Mi Kang
- BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of, Korea
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Guilhen TA, Vieira ABM, de Castro MC, Hirata HH, Machado IR. Evaluation of surgical treatment of Dupuytren's disease by modified open palm technique. Rev Bras Ortop 2014; 49:31-6. [PMID: 26229769 PMCID: PMC4511695 DOI: 10.1016/j.rboe.2014.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/20/2013] [Indexed: 11/18/2022] Open
Abstract
Objective to assess the surgical technique using the modified palm open technique for the treatment of severe contractions of Dupuytren's disease. Methods over a period of four years, 16 patients underwent surgical treatment, and in its entirety belonged to stages III and IV of the classification proposed by Tubiana et al. We performed measurements of the extension deficit of the metacarpophalangeal joints, proximal and distal interphalangeal in preoperative, postoperative (3 months) and late postoperative period (5–8 years). Angles greater than 30° metacarpophalangeal joints and 15° proximal interphalangeal the results were considered surgical recurrence. Results there was obtained an average of 6.3° at the metacarpophalangeal joint, 13.8° in the proximal interphalangeal and distal interphalangeal at 1.9°. Conclusion the modified open palm technique is an effective method in the surgical treatment of severe contractures in Dupuytren's disease.
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Avaliação do tratamento cirúrgico da doença de Dupuytren pela técnica da palma aberta modificada. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Motolese A, Mola F, Cherubino M, Giaccone M, Pellegatta I, Valdatta L. Squamous cell carcinoma and ledderhose disease: a case report. INT J LOW EXTR WOUND 2013; 12:297-300. [PMID: 24214953 DOI: 10.1177/1534734613502044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ledderhose disease is disorder of the plantar aponeurosis. This disease is not so common and can be tackled with a surgical or conservative approach. A case of a 73-year-old man came to our attention who had a 26-year history of painless bilateral plantar nodules coalescing into an indurated mass. An ulcerative nodule had been noted in the last 16 months on the right foot, in the absence of trauma, not responsive to conservative treatment, so we decided to perform a biopsy. The histopatologic examination showed squamous cell carcinoma, with warty, well-differentiated, low-grade malignancy. Surgical treatment was suggested, so, in pneumoischemia, we made a surgical incision including the skin lesion. Then we proceeded to sculpture the anterolateral thigh fasciacutaneous flap to obtain adequate soft tissue coverage. The tumor was completely removed. Current reconstructive possibilities comprise a good anatomofunctional recovery even in the case of large demolition requests for the therapy of advanced cases of the disease described in this article. Correlation between Ledderhose disease and the formation of malignant tumors has not been made as yet, but perhaps an element that could unite these pathologies can be researched in the lively cell proliferation that characterizes both. It would be interesting to analyze the biological substrate, as well as the systemic and local levels, in patients where both diseases are manifested.
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Johnson AW, Shubrook JH. Role of Osteopathic Structural Diagnosis and Osteopathic Manipulative Treatment for Diabetes Mellitus and Its Complications. J Osteopath Med 2013; 113:829-36. [DOI: 10.7556/jaoa.2013.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Osteopathic physicians have a unique opportunity to affect the US epidemic of type 2 diabetes mellitus (T2DM). Osteopathic physicians make up a disproportionately high number of primary care physicians who are on the front lines of managing T2DM. In addition, the unique training of osteopathic physicians allows them to direct additional diagnostic and treatment modalities toward the musculoskeletal complications of diabetes. The present review surveys the literature that explores the effects of osteopathic structural diagnosis of and osteopathic manipulative treatment for T2DM, as well as the management and prevention of complications. The authors reviewed the databases for PubMed, Google Scholar, and The Journal of the American Osteopathic Association. Although the available literature is limited, the authors identify areas in which osteopathic-focused research has shown benefits and in which future research should be directed.
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Dahlin LB, Bainbridge C, Leclercq C, Gerber RA, Guerin D, Cappelleri JC, Szczypa PP, Dias J. Dupuytren's disease presentation, referral pathways and resource utilisation in Europe: regional analysis of a surgeon survey and patient chart review. Int J Clin Pract 2013; 67:261-70. [PMID: 23409694 DOI: 10.1111/ijcp.12099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/26/2012] [Indexed: 11/28/2022] Open
Abstract
AIM We explored the management of Dupuytren's disease (DD) using a surgeon survey and patient chart review. METHODS Twelve countries participated: Denmark, Finland, Sweden (Nordic region); Czech Republic, Hungary, Poland (East); France, Germany, the Netherlands, United Kingdom (West); Italy, Spain (Mediterranean). A random sample of orthopaedic/plastic surgeons (N = 687) with 3-30 years' experience was asked about Dupuytren's contracture procedures performed during the previous 12 months. Information ≤ 5 consecutive patients per surgeon was extracted from patient charts (N = 3357). RESULTS Overall, 84% of participants were orthopaedic surgeons; 56% of surgeons were hand specialists. Deciding factors for fasciectomy and dermofasciectomy were consistent across regions: metacarpophalangeal (MP) or proximal interphalangeal contracture > 45°, recurrent contracture, and high expectations for success. Deciding factors for percutaneous needle fasciotomy were less consistent across regions, but the leading factor was MP flexion < 20°. Overall, 49% of diagnoses and 55% of referrals were made by a general practitioner (GP), with regional variation: 31-77% for GP diagnoses and 36-81% for GP referrals. There were also differences in admission status (e.g. 9% of Nordic patients and 80% of Eastern patients were treated as inpatients). Most patients were treated in public hospitals and most procedures were covered by public health insurance. CONCLUSIONS We found regional variations in surgical practice, patient characteristics and referral patterns. Understanding current diagnosis and treatment patterns, in relation to regional differences in health economics, may improve physicians' diagnosis of DD and guide patients towards appropriate, customised management plans.
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Affiliation(s)
- L B Dahlin
- Department of Clinical Sciences - Hand Surgery, Lund University, Skåne University Hospital Malmö, Malmö, Sweden.
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Cutolo CA, Lombardo S, Verticchio Vercellin AC, Bertone C, De Amici M, Antoniazzi E, Milano G. Cataracts and Dupuytren disease: a case report and review of the literature. Eur J Ophthalmol 2012; 23:0. [PMID: 23138664 DOI: 10.5301/ejo.5000208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/20/2022]
Abstract
Purpose. Dupuytren disease is an inherited proliferative and progressive connective disease. Ectopic disease may, however, be located distant from the palmar fascia.
Methods. Case report and review of the literature.
Results. We describe a case of symmetric bilateral posterior subcapsular cataracts associated with symmetric bilateral Dupuytren disease and symmetric bilateral Ledderhose disease in a 56-year-old Caucasian man. His medical history was negative for glucocorticoids intake, diabetes, and exposure to radiation. Serum transforming growth factor β (TGF-β)1 concentration has been evaluated and was found to be almost double compared to the controls.
Conclusions. We speculate that the TGF-β plays an important role for ocular and connective tissue disorders.
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Affiliation(s)
- Carlo A Cutolo
- University Eye Clinic, Foundation IRCCS Policlinico San Matteo, Pavia - Italy
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Ratkaj I, Bujak M, Jurišić D, Baus Lončar M, Bendelja K, Pavelić K, Kraljević Pavelić S. Microarray analysis of Dupuytren's disease cells: the profibrogenic role of the TGF-β inducible p38 MAPK pathway. Cell Physiol Biochem 2012; 30:927-42. [PMID: 22965824 DOI: 10.1159/000341470] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Dupuytren's disease (DD) is a nodular palmar fibromatosis that causes irreversible permanent contracture of fingers and results in the loss of hand function. Surgery still remains the only available solution for DD patients but cannot permanently cure the disease nor reduce high recurrence rates. With this rationale, we designed a study aimed at an improved understanding of the molecular mechanisms underlying DD. Our major focus was an analysis of the global gene expression profile and signalling pathways in DD cells with the aim of identifying novel biomarkers and/or therapeutic targets. METHODS Primary cells were cultured from surgically removed diseased and healthy tissue. Microarray expression analysis (HG-U133A array, Affymetrix) and qPCR was performed with total RNA isolated from primary DD cells. Mechanistic studies involving inhibition of p38 phosphorylation were performed on normal human fibroblasts' and primary DD cells' in vitro models. Expression of stem cell markers in primary fibroblasts/myofibroblasts was assessed as well. RESULTS We identified 3 p38MAPK signalling pathway regulatory genes, THBS1, GADD45α and NUAK1, all involved in cellular proliferation and production of the extracellular matrix proteins. Inhibition of the p38MAPK signalling pathway induced down-regulation of myofibroblast markers, α-smooth muscle actin and palladin. A stem-cell like subpopulation positive for CD90 marker was identified among primary DD cells. CONCLUSION The study reveals involvement of the p38 MAPK pathway as a possible signalling cascade in the pathogenesis of Dupuytren's disease. Moreover, a particular stem cell-like CD90(+) subpopulation was identified that might contribute to DD development.
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Affiliation(s)
- Ivana Ratkaj
- University of Rijeka, Department of Biotechnology, Rijeka, Croatia
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Bismil Q, Bismil M, Bismil A, Neathey J, Gadd J, Roberts S, Brewster J. The development of one-stop wide-awake dupuytren's fasciectomy service: a retrospective review. JRSM SHORT REPORTS 2012; 3:48. [PMID: 22908029 PMCID: PMC3422854 DOI: 10.1258/shorts.2012.012050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives To detail the transition to a totally one-stop wide-awake (OSWA) Dupuytren's contracture surgical service. Design Retrospective review of Dupuytren's component of last 1000 OSWA cases. Setting The UK's first totally one-stop wide-awake orthopaedic service. Participants 270 patients with Dupuytren's contracture out of the last 1000 OSWA cases. Main outcome measures Surgical outcomes, patient satisfaction and cost-effectiveness and efficiency. Results The OSWA Dupuytren's model is safe, efficient and effective; with a low complication rate, extremely high patient satisfaction; and cost-savings to the nhs of £2500 per case treated. The service saved the NHS approximately £675,000 for the 270 cases presented. Conclusions A totally one-stop wide-awake Dupuytren's Contracture service is practicable and feasible alternative to the conventional treatment pathway, with benefits in terms of efficiency and cost-effectiveness.
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Affiliation(s)
- Qmk Bismil
- Consultant Orthopaedic Surgeon, The Wellington Hospital , London NW8 9LE , UK
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Miranda BH, Elliott C, Fahmy FS. Bilateral Dupuytren's contractures of the thumb interphalangeal joints. J Plast Reconstr Aesthet Surg 2012; 65:1738-40. [PMID: 22652288 DOI: 10.1016/j.bjps.2012.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 04/26/2012] [Indexed: 11/17/2022]
Abstract
Dupuytren's disease was first described by Baron Guillaume Dupuytren in 1831. He outlined the pathology of palmar fascia thickening and contracture resulting in flexion of one or more digits. Dupuytren's disease usually affects the little or ring fingers, with the thumb rarely affected. Furthermore, the thumb in isolation is only affected in 0.5% of cases, with contracture at the metacarpophalangeal joint. We present a unique and interesting case of Dupuytren's disease predominantly of the thumbs, with isolated contractures bilaterally at the interphalangeal joints, in a 59 year old lady with epilepsy who was otherwise fit and well. To our knowledge this disease pattern has never been reported in the literature. Furthermore a relevant literature review of Dupuytren's disease affecting the thumb, in particular the interphalangeal joint, is presented. Our interesting and unique case reinforces the notion that the disease pathogenesis is diverse and multifactorial, and provides a further interesting example for the literature.
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Affiliation(s)
- B H Miranda
- Plastic & Reconstructive Surgery Department, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Health Park, Liverpool Road, Chester CH2 1UL, UK.
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