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

Dupuytren's disease is very common, with a prevalence of up to 40% in the Scandinavian population. Although many epidemiological surveys have been conducted, little is known about its aetiology. Multiple risk factors in Dupuytren's disease have been identified. About 80% of the affected patients are male. Even though recent data suggest similar outcome after surgical treatment in the female patient, recurrence after surgery is more frequent. To assess Dupuytren's disease in women, a record analysis and a survey of risk factors was conducted in 130 female patients surgically treated at our institution between 1988 and 2005. With a response rate of 52%, 65 women were included (6 patients were confirmed dead). The mean age of onset of the disease was 50 years and 6 months. After a mean follow-up of 7 years and 7 months (2y1m to 21y9m), recurrent disease after surgery was reported in 42%. Bilateral disease was present in 54%, unilateral in 26% right and 20% left hands. The fifth finger was involved in 77%, the 4th finger in 48% and the 1st ray in 14%. Ectopic lesions were seen in 19%, with a positive family history in 55%. Only one patient had a confirmed alcohol abuse; 22% were smokers. There were 32% manual workers. Shoulder pain was present in 54% of the patients, with confirmed diagnosis of frozen shoulder syndrome in 45%. High cholesterol was diagnosed in 39% and only 6% had diabetes. Epilepsy was seen in 5%. High disease recurrence and factors related to an aggressive course of the disease are present in female patients with Dupuytren's contracture, with a high family history occurrence, bilateral disease and associated Ledderhose disease. Several known risk factors were present: high cholesterol, smoking and manual work. Frozen shoulder showed a very high prevalence in women with Dupuytren's disease.
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PMID:A survey of clinical manifestations and risk factors in women with Dupuytren's disease. 1881 Oct 27

Dupuytren's contracture is a connective tissue disorder characterized by contractile palmar aponeurosis leading to shortening and progressive digital flexion deformity. Various investigators have proposed many theories and documented several findings regarding the aetiology of Dupuytren's contracture. However, none of them explains the causes well enough. Most studies have found relationships between the disorder and manual labor, previous hand injures, genetic susceptibility, diabetes mellitus, epilepsy, high cholesterol level profile and intake of either alcohol or tobacco. However, according to others, the evidence on risk factors associated with certain lifestyles has been conflicting. This article reviews the most common theories regarding the aetiology of Dupuytren's contracture such as genetic, microinjury, immunological, toxic and ischaemic theories.
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PMID:[Etiology of Dupuytren's contracture]. 1884 12

Reported is the case of a 68-year-old male presenting with severe wrist and hand stiffness following surgery for a Dupuytren's contracture. Complications of surgery or rehabilitation and complex regional pain syndrome were excluded as factors explaining this stiffness. Given the patient's diabetes mellitus and the striking similarity with the typical diabetic stiff hand, it is suggested that diabetes may have contributed to the development of the complication.
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PMID:A diabetic patient presenting with stiff hand following fasciectomy for Dupuytren's contracture: A case report. 1895 58

The manifestations of diabetes in the hand were much discussed in the 1970s and 1980s. The present review aims to revisit the diabetic hand and to discuss the pathology of the hand that may be clinically important in diabetic patients. In the strict sense of the term, the "diabetic hand" encompasses the three most widely studied conditions which have traditionally been associated with diabetes, namely limited joint mobility, Dupuytren's contracture and trigger finger. There is evidence that these entities are significantly more frequent in patients with diabetes and also that they may be associated with diabetes duration, poor metabolic control and presence of microvascular complications. In a more general sense, though, there are other conditions affecting the hands, which also occur more frequently in diabetes. From a practical point of view, increased alertness both for neuropathic hand ulcers in patients with profound neuropathy and for diabetic hand infections is absolutely necessary. Recently, reduced hand strength is beginning to be recognized as a further complication of diabetes. Thus, the hand may reveal substantial pathology in diabetes, and ideally, clinical examination should not ignore it.
J Diabetes Complications
PMID:The diabetic hand: a forgotten complication? 1921 19

We randomised 79 patients (84 hands, 90 fingers) with Dupuytren's contracture of the proximal interphalangeal joint to have either a 'firebreak' skin graft (39 patients, 41 hands, 44 fingers) or a fasciectomy (40 patients, 43 hands, 46 fingers) if, after full correction, the skin over the proximal phalanx could be easily closed by a Z-plasty. Patients were reviewed after three, six, 12, 24 and 36 months to note any complications, the range of movement and recurrence. Both groups were similar in regard to age, gender and factors considered to influence the outcome such as bilateral disease, family history, the presence of diabetes, smoking and alcohol intake. The degree of contracture of the metacarpophalangeal and interphalangeal joints of the operated fingers was similar in the two groups and both were comparable in terms of grip strength, range of movement and disability at each follow-up. The recurrence rate was 12.2%. We did not identify any improvement in correction or recurrence of contracture after firebreak dermofasciectomy up to three years after surgery.
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PMID:Does a 'firebreak' full-thickness skin graft prevent recurrence after surgery for Dupuytren's contracture?: a prospective, randomised trial. 1925 15

Peyronie's disease (PD) is a localized fibrotic condition of the tunica albuginea that is associated with risk factors for corpora cavernosa fibrosis (such as advanced age and diabetes) and Dupuytren contracture, another localized fibrotic process. Most of the current pharmacological treatments for PD are not based on antifibrotic approaches that have shown promising results in animal models and clinical efficacy in other fibrotic conditions, which may explain why they are generally unsuccessful. Evidence gathered in human specimens and animal models of PD have elucidated aspects of its etiology and histopathology, showing that overexpression of transforming growth factor beta1, plasminogen activator inhibitor 1, reactive oxygen species and other profibrotic factors, which are, in most cases, assumed to be induced by trauma to the tunica albuginea, leads to myofibroblast accumulation and excessive deposition of collagen. At the same time, a steady overexpression of inducible nitric oxide synthase, leading to increased nitric oxide and cGMP levels, seems to act as an endogenous antifibrotic mechanism. This process has also been reported in corporal and cardiovascular fibrosis, and has led to the demonstration that long-term continuous administration of phosphodiesterase type 5 inhibitors counteracts the development of a PD-like fibrotic plaque in a rat model, and later extended to the prevention of corporal fibrosis in animal models of erectile dysfunction.
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PMID:Treatment of Peyronie's disease with PDE5 inhibitors: an antifibrotic strategy. 2021 16

Dupuytren's contracture is a retractile fibrosis of the superficial palmar aponeurosis of the hand, resulting in a progressive and fixed flexion of the fingers that may result in severe limitation of hand function. It affects several millions of people in Europe and North America. Risk factors are genetic and sometimes related to mellitus diabetes. There is no spontaneous remission. Until recently, surgery was the only treatment, but now needle aponeurotomy emerges as a therapeutic alternative. It should be performed as first line treatment by a trained practitioner. Short and long-term results of needle aponeurotomy appear identical to those of surgery, with milder complications. It is indicated in palmar, palmo-digital, as well as in strictly digital forms of the disorder. The "table-test" is used to assess the loss of extension of the digit and to select the indication to needle aponeurotomy. A medico-surgical consensus should define the optimum treatment strategy in this affection.
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PMID:[Dupuytren's contracture: percutaneous needle aponeurotomy is an alternative to surgery]. 2082 92

Dupuytren disease (DD) is a fibroproliferative disorder of unknown etiology that often results in shortening and thickening of the palmar fascia, leading to permanent and irreversible flexion contracture of the digits. This Review provides a detailed update of the scientific understanding of DD and its clinical management, with perspectives on emerging research and therapy. Established risk factors include genetic predisposition and ethnicity, as well as sex and age. Several environmental risk factors (some considered controversial) include smoking, alcohol intake, trauma, diabetes, epilepsy and use of anticonvulsant drugs, and exposure to vibration. DD has been variously attributed to the presence of oxygen free radicals, trauma to the palmar fascia, or aberrant immune responses with altered antigen presentation, or to interactions between these proposed mechanisms. The presence of immune cells and related phenomena in DD-affected tissue suggests that DD is possibly immune-related. Mechanically, digital contracture is caused by myofibroblasts in the DD palmar fascia; however, the exact origin of this cell type remains unknown. The mainstay of treatment is surgical release or excision of the affected palmodigital tissue, but symptoms often recur. Nonsurgical correction of DD contractures can be achieved by Clostridium histolyticum collagenase injection, although the long-term safety and recurrence rate of this procedure requires further assessment.
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PMID:Scientific understanding and clinical management of Dupuytren disease. 2106 Mar 35

In order to investigate the prognostic value of possible risk factors for Dupuytren's diathesis, clinical parameters on disease presentation in an operated group of patients were compared with self-reported recurrence after a minimum 2 years follow-up. In order of significance, the following factors were found to be significantly correlated with disease recurrence : age of onset under 50 years (p = 0.01), bilateral disease (p = 0.01), Ledderhose disease (p = 0.01), first ray involvement (p = 0.02), multiple ray involvement (more than 2 digits, p = 0.02), ectopic fibromatosis (p = 0.02), family occurrence (p = 0.04) and male gender (p = 0.05). No correlation of self-reported disease recurrence was seen with diabetes, frozen shoulder syndrome or epilepsy. An insight in the significance of the influence of specific risk factors on recurrence rates, helps in creating a clearer representation of Dupuytren's diathesis. This will help the surgeon to more accurately inform the patient and possibly to reconsider and adjust the choice in treatment options.
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PMID:Risk factors in Dupuytren's diathesis: is recurrence after surgery predictable? 2147 42

Musculoskeletal disorders are common in diabetic subjects. The pathophysiology of these disorders in diabetic patients is not obvious. It could be due to connective tissue disorders, glycosylated end products, vasculopathy, neuropathy or combinations. A wide range of musculoskeletal syndromes have been described in association with diabetes, namely diabetic cheiro-arthropathy, adhesive capsulitis of shoulder, carpal tunnel syndrome, Dupuytren's contracture, hyperostosis, osteo-arthritis, hyperuricaemia, etc. This study was undertaken to find out the prevalence of these conditions in diabetes mellitus and to look for any associations with diabetic complications or therapy. A tertiary care centre-based cross-sectional study was carried out among 100 consecutive diabetic patients (WHO criteria) attending medicine department who were enrolled. The study was done at Calcutta National Medical College and Hospital, Kolkata, from March 2008 to February 2009. The diagnoses of the rheumatic conditions were made by unbiased clinical observations on the basis of standardised case definitions or criteria. Limited joint mobility (29%), adhesive capsulitis (18%), and osteo-arthritis of knee (27%) or hand (17%) were the most common rheumatic conditions in diabetics. Trigger finger (flexor tenosynovitis) and carpal tunnel syndrome were also present in 7% and 5% cases of diabetics respectively. Although hyperuricaemia was present in 9%, clinical gout was present in only 4%. There was no clear association of these syndromes with diabetic renal disease or micro-albuminuria. Most of these conditions were noted in chronic long duration diabetic subjects.
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PMID:Prevalence of rheumatic conditions in patients with diabetes mellitus in a tertiary care hospital. 2188 66


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