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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over a 5-year period, 75 shoulders that met Codman's criteria for primary frozen shoulder were treated. Nine patients improved with nonoperative treatment, and the remaining 66 patients underwent manipulation under anesthesia. The shoulders in 41 patients successfully released with manipulation. Those in 25 failed to release with manipulation, and therefore, these patients underwent open surgical release of the contracted shoulder. We reviewed the cases of all of the surgically treated patients at 19.52 months' average follow-up, using the history and clinical examination technique recommended by the American Shoulder and Elbow Surgeons. The surgical findings in this group of 25 patients showed a consistent alteration in the rotator interval and coracohumeral ligament. The rotator interval was obliterated, and the coracohumeral ligament was transformed into a tough contracted band. The histology of this contracture was examined in 12 patients and consisted of a dense matrix of type III collagen populated with fibroblasts and myofibroblasts. The contracted coracohumeral ligament was excised with immediate release of the external rotation deficit. Pain scores on visual analogue scale improved from 8.28 to 2.0. The average score for function, with a maximum score of 30, improved from 6.08 to 18.9. Twenty patients had excellent or good results, and 3 had fair results. The shoulders of 2 patients failed to improve: 1 was an insulin-dependent patient with diabetes, and 1 had severe bilateral Dupuytren's contractures. The results in the patients without diabetes were very satisfactory, with visual analogue scale scores of pain decreasing from 8.4 to 1.1, function increasing from 6.4 to 20.1, flexion increasing from an average of 96 degrees to an average of 131 degrees, and external rotation increasing from an average of 10.0 degrees to an average of 46.7 degrees. Surgical release of frozen shoulder is a useful option in those few patients with severe disease whose shoulders fail to release with manipulation under anesthesia. Caution should be used in insulin-dependent patients with diabetes.
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PMID:Open surgical release for frozen shoulder: surgical findings and results of the release. 1198 35

In order to study possible connections between Dupuytren's contracture and sarcoma we analysed the records of 18 patients who developed sarcoma 5 years or more after surgery for Dupuytren's contracture. We found an increased frequency of fibrosarcoma and malignant fibrous histiocytoma, but these patients did not differ from the other patients in the study group. Our analysis suggests that neither smoking, diabetes nor cancer syndromes can explain why patients with Dupuytren's contracture have a higher incidence of sarcoma.
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PMID:Dupuytren's contracture and sarcoma. 1189 46

Heightened awareness of endocrine abnormalities is important in evaluation of patients presenting with musculoskeletal symptoms. Endocrine disorders such as diabetes, hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoparathyroidism, hyperadrenocorticism, and acromegaly cause a unique array of rheumatic manifestations. Such conditions include Dupuytren's contracture, carpal tunnel syndrome, chondrocalcinosis, pseudogout, scleredema, and osteoporosis. Characteristic changes on radiologic evaluation and serum enzyme testing are additional clues to these atypical presentations. Consideration of a possible endocrine cause early in the evaluation may improve management in patients with such an underlying disorder.
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PMID:Endocrine origins of rheumatic disease. Diagnostic clues to interrelated syndromes. 1198 36

We investigated 103 consecutive patients operated on for Dupuytren's contracture (DC) to find out the relation between the expression of activation markers of connective tissue in surgical specimens obtained prospectively and recurrence of disease. The history of the disease and present state of the operated hand were obtained a mean of 4 years (range 2.5-6) after the latest operation. Immunohistochemical staining for anticollagen type IV, integrin alpha5, laminin, smooth muscle beta-actin, procollagen type I, and desmin was evaluated. Almost half of the patients noticed recurrences during the study period, one fifth within six months of operation. No differences in the expression of any of the markers investigated were found, either earlier or later than six months postoperatively, in patients with or without recurrent bending. Furthermore, there were no associations between sex, age at onset, number of operations, heredity, diabetes mellitus, or drugs taken for cardiovascular disease, and the expression of any of the immunohistochemical markers. The individual characteristics that place a person at high risk are not obviously related to ongoing production of connective tissue at the time of operation or to connective tissue activity in its conventionally-used sense.
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PMID:Activation markers of connective tissue in Dupuytren's contracture: relation to postoperative outcome. 1464 87

Dupuytren's is a common problem, but little is known about its aetiology. We have undertaken a large case-control study to assess and quantify the relative contributions of diabetes and epilepsy as risk factors for Dupuytren's in the community. Cases were patients with a diagnosis of Dupuytren's disease and, for each, two controls were individually matched by age, sex, and general practice. Our dataset included 821 cases and 1,642 controls. Five hundred and eighty-eight (72%) of the cases were men. The mean age at diagnosis was 62 (range 24-97) years. Diabetes was a significant risk factor for Dupuytren's disease (OR=1.75) and there was an increased risk for medicinally treated diabetes (metformin--OR=3.56; sulphonylureas--OR=1.75) and particularly insulin controlled (OR=4.38) rather than diet-controlled diabetes. Epilepsy (OR=1.12) and anti-epileptic medications were not associated with Dupuytren's disease. Ascertainment bias in previous studies may explain the reported association with epilepsy.
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PMID:Dupuytren's disease risk factors. 1533 42

Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycaemia with resultant morbidity and mortality related to its microvascular and macrovascular complications. In addition diabetes is also associated with several musculoskeletal disorders of the hand, that can be debilitating. There is increased incidence of these abnormalities in patients with type 1 and type 2 diabetes compared with the general population, related to disease duration but not to the age or sex. Typical diabetes associated hand condition include the palmar flexor tenosynovitis, Dupuytren's contracture, syndrome of limited joint mobility, carpal tunnel syndrome, Charcot arthropathy and reflex sympathetic dystrophy. Maintaining good glycaemic control by exercise, diet and drugs improves or prevents the development of these hand rheumatic condition. In this brief report we review the rational therapeutic approach to these disorders.
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PMID:[The diabetic hand]. 1547 May 18

Hand abnormalities, represented by Dupuytren's contracture, limited joint mobility, carpal tunnel syndrome, flexor tenosynovitis,occur in approximately 50% of the diabetic patients, affecting their activity and decreasing the quality of their life. Using specific methods, these can by detected long before they are observed by the patients. These disturbances have a high prevalence inthe persons with long diabetes mellitus duration, the prevalence increasing with the age. Smoking, usual hard activities, bad metabolic control and so on, can increase the severity of these disturbances. It is compulsory a careful examination of the patients' hands, because more abnormalities can be surgically rightened.
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PMID:Hand abnormalities of the patients with diabetes mellitus. 1552 76

The typical Dupuytren's disease patient is of Northern European descent with bilateral progressive multiple digital contractures and is genetically predisposed, with a family history. Palmar fascial proliferations sometimes present as a different entity without the typical Dupuytren's disease characteristics. We identified 39 patients (20 women and 19 men) over a 4-year period with "Non-Dupuytren's palmar fascial disease", with unilateral involvement, without family history or ectopic manifestations. Twenty-three patients presented with unrelated complaints and were discovered, incidentally, to have the condition. In 28 patients, prior ipsilateral hand surgery or trauma precipitated the condition. Other related factors were diabetes mellitus and cardiovascular disease. Ten patients had skin tethering and subcutaneous thickening akin to Dupuytren's nodules and 29 had palmar fascial thickening into ill-defined pretendinous cords. The diseased tissue was in the line of the ring finger in 30 patients. The time from insult to onset of contracture averaged 3.6 months and from onset to follow-up averaged 5.3 years. The condition was non-progressive, or partially regressive, in 33 patients. Seven patients had operations for unrelated conditions and underwent simultaneous fasciectomy without recurrence. Environmental factors, especially trauma, surgery and diabetes, are important in the pathogenesis of Non-Dupuytren's palmar fascial disease, but these patients do not appear to be genetically predisposed for Dupuytren's disease. Typical Dupuytren's disease and Non-Dupuytren's palmar fascial disease are two clinical entities that run different courses and do not share a similar prognosis. This should be taken into account in future epidemiological and outcome studies.
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PMID:Non-Dupuytren's disease of the palmar fascia. 1620 68

Patients with diabetes mellitus may encounter various musculoskeletal complications. Typical manifestations can be seen in the hand, such as limited joint mobility, flexor tendon synovitis, Dupuytren's contracture and carpal tunnel syndrome. Humeral periarthropathy is also more frequent. The most serious complications can occur in the form of diabetic foot, which may lead to severe deformities and disability. Diabetic amyotrophy and muscle infarction are more rare complications. While osteopenia has a well recognized association with type I diabetes mellitus, this probably is not true for type II. Similarly, the association between diabetes mellitus and osteoarthritis has not been proven.
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PMID:[Rheumatologic manifestations in diabetes]. 1677 Oct 95

This study aimed to investigate the prevalence of the most frequently occurring hand and shoulder complications in type 2 diabetes mellitus patients. The presence of cheiroarthropathy, frozen shoulder, Dupuytren's contracture and trigger finger was assessed in 102 type 2 diabetes mellitus patients and 101 age- and sex-matched non-diabetic controls. The relationship between these complications and patients' age, sex, duration of diabetes and glycaemic control was also analysed. Cheiroarthropathy, frozen shoulder and Dupuytren's contracture were significantly more prevalent in the diabetic group than in the control group. Females were slightly more affected with frozen shoulder than males and advanced cases (stage 2) of cheiroarthropathy occurred more frequently in females. Duration of diabetes was related to an increased risk of cheiroarthropathy. In conclusion, some musculoskeletal disorders are more prevalent in type 2 diabetes mellitus patients and this may be associated with glycaemic control, sex and duration of diabetes.
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PMID:Which musculoskeletal complications are most frequently seen in type 2 diabetes mellitus? 1853 32


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