RESUMEN
BACKGROUND: Diabetes (regardless of type) and obesity are associated with a range of musculoskeletal disorders. The causal mechanisms driving these associations are unknown for many upper limb pathologies. We used genetic techniques to test the causal link between glycemia, obesity and musculoskeletal conditions. METHODS: In the UK Biobank's unrelated European cohort (N = 379â708) we performed mendelian randomisation (MR) analyses to test for a causal effect of long-term high glycaemia and adiposity on four musculoskeletal pathologies: frozen shoulder, Dupuytren's disease, carpal tunnel syndrome and trigger finger. We also performed single-gene MR using rare variants in the GCK gene. RESULTS: Using MR, we found evidence that long-term high glycaemia has a causal role in the aetiology of upper limb conditions. A 10-mmol/mol increase in genetically predicted haemoglobin A1C (HbA1c) was associated with frozen shoulder: odds ratio (OR) = 1.50 [95% confidence interval (CI), 1.20-1.88], Dupuytren's disease: OR = 1.17 (95% CI, 1.01-1.35), trigger finger: OR = 1.30 (95% CI, 1.09-1.55) and carpal tunnel syndrome: OR = 1.20 (95% CI, 1.09-1.33). Carriers of GCK mutations have increased odds of frozen shoulder: OR = 7.16 (95% CI, 2.93-17.51) and carpal tunnel syndrome: OR = 2.86 (95% CI, 1.50-5.44) but not Dupuytren's disease or trigger finger. We found evidence that an increase in genetically predicted body mass index (BMI) of 5 kg/m2 was associated with carpal tunnel syndrome: OR = 1.13 (95% CI, 1.10-1.16) and associated negatively with Dupuytren's disease: OR = 0.94 (95% CI, 0.90-0.98), but no evidence of association with frozen shoulder or trigger finger. Trigger finger (OR 1.96 (95% CI, 1.42-2.69) P = 3.6e-05) and carpal tunnel syndrome [OR 1.63 (95% CI, 1.36-1.95) P = 8.5e-08] are associated with genetically predicted unfavourable adiposity increase of one standard deviation of body fat. CONCLUSIONS: Our study consistently demonstrates a causal role of long-term high glycaemia in the aetiology of upper limb musculoskeletal conditions. Clinicians treating diabetes patients should be aware of these complications in clinic, specifically those managing the care of GCK mutation carriers. Upper limb musculoskeletal conditions should be considered diabetes complications.
Asunto(s)
Bursitis , Síndrome del Túnel Carpiano , Diabetes Mellitus , Contractura de Dupuytren , Hiperglucemia , Enfermedades Musculoesqueléticas , Trastorno del Dedo en Gatillo , Humanos , Contractura de Dupuytren/epidemiología , Contractura de Dupuytren/genética , Contractura de Dupuytren/complicaciones , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/genética , Síndrome del Túnel Carpiano/complicaciones , Trastorno del Dedo en Gatillo/complicaciones , Hiperglucemia/complicaciones , Hiperglucemia/epidemiología , Hiperglucemia/genética , Extremidad Superior , Enfermedades Musculoesqueléticas/complicaciones , Factores de Riesgo , Bursitis/complicaciones , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/genéticaRESUMEN
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).
Asunto(s)
Contractura de Dupuytren , Humanos , Masculino , Adulto , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/cirugía , Articulaciones de los Dedos/cirugía , Articulaciones de los Dedos/patología , Dedos/cirugía , Dedos/patología , Mano , FasciaRESUMEN
The current study ushers in a comprehensive review in clinical research to demonstrate the prevalence of musculoskeletal (MSK) complications in diabetes mellitus and the most relevant clinical aspects. In particular, revealing the early symptoms of the disorders, the pathology lurking behind the complications and their optimal management. In diabetes mellitus, MSK complications are common and are largely due to similar pathogenetic factors responsible for the internal organ complications associated with diabetes leading to chronic low-intensity inflammatory processes. MSK disorders develop by vasculopathy, neuropathy, arthropathy or combinations of the above, which are not specific to diabetes. However, their prevalence is significantly increased in diabetes and contributes to the disability impairing patients' quality of life. Locomotor disease affects approximately 34.4-83.5 % of patients suffering from type-2 diabetes mellitus. Several musculoskeletal abnormalities (cheiroarthropathy, Dupuytren's contracture, trigger finger, ect.) can be diagnosed upon physical examination, although certain symptoms (frozen shoulder, neurogenic arthropathy, septic arthritis, etc.) require differential diagnostic considerations. Early identification regarding characteristic symptoms in the treatment reducing inflammation and pain, followed with increasingly strenuous exercise therapy, aligned with optimal management of carbohydrate metabolism, proves essential in alleviating MSK complications.
Asunto(s)
Diabetes Mellitus Tipo 2 , Contractura de Dupuytren , Artropatías , Enfermedades Musculoesqueléticas , Humanos , Calidad de Vida , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/terapia , Artropatías/complicaciones , Artropatías/epidemiología , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapiaRESUMEN
Background: Arthrofibrosis is a complication of total knee arthroplasty (TKA) that can lead to poor outcome. Idiopathic arthrofibrosis and Dupuytren disease (DD) have similar histological appearance. The aim of this study is to determine the influence of DD on the recovery of motion after TKAy. Methods: Patients older than 50 who underwent a TKA for primary osteoarthritis were examined 1 year later for the presence of DD. They were divided into two groups based on the presence or absence of DD. The groups were compared to each other with regard to arc of motion (AOM) of the operated knee at 6 weeks and 1 year; the need for additional measures to improve the AOM, and the effect of obesity [body mass index (BMI) > 30]. Results: The study included 61 patients of which 25 (41%) had DD. There was no difference in AOM at 6 weeks or 1 year between the two groups. Patients in the DD group required a greater number of additional measures to improve AOM. Also, non-obese patients (BMI < 30) in the DD group had lower AOM at 1 year. Conclusions: Patients in the DD group needed additional physiotherapy or manipulation under anaesthesia (MUA) to achieve the same AOM. This might indicate a possible connection between DD and post-operative stiffness of the knee. Identifying patients with DD in the pre-operative period may help recognise patients who may have difficulty in regaining AOM after TKA. Level of Evidence: Level III (Therapeutic).
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Contractura de Dupuytren , Artropatías , Artroplastia de Reemplazo de Rodilla/efectos adversos , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/cirugía , Humanos , Artropatías/cirugía , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Rango del Movimiento ArticularRESUMEN
STUDY DESIGN: Cross-sectional INTRODUCTION: Globally, diabetes is a leading cause of disability with an increased prevalence rate in the past three decades. Chronic diabetes has been shown to affect collagenous tissue which often leads to subsequent musculoskeletal complications. Despite increasing prevalence of musculoskeletal disorders, the proportion and distribution of types of upper extremity musculoskeletal disorders resulting in disabilities is poorly understood. PURPOSE OF THE STUDY: This cross-sectional study aims to gather data on the prevalence, proportion and distribution of upper extremity musculoskeletal disorders among individuals with Type 2 Diabetes Mellitus. Further, this study examines the relationship between common upper extremity disorders and the resulting disability among individuals with Type 2 Diabetes Mellitus. METHODS: 170 individuals diagnosed with Type 2 Diabetes Mellitus were recruited at a tertiary care hospital. Routine upper extremity assessments were performed to identify the presence of Frozen Shoulder (FS), Limited Joint Mobility (LJM), Trigger Finger, Carpal Tunnel Syndrome (CTS), and Dupuytren's Contracture. Disability was measured using the Disabilities of arm, shoulder, and hand (DASH) questionnaire. Descriptive statistics, one-way analysis of variance, Tukey's test, and Pearson's test were used to examine the prevalence, proportion and distribution of musculoskeletal disorders and disabilities among individuals with type 2 Diabetes Mellitus. RESULTS: 83(48.9%) participants had one or a combination of multiple musculoskeletal disorders of the upper extremity. The proportion of LJM, FS, CTS, Trigger Finger, and Dupuytren's Contracture were n = 46(27.1%); n = 43(25.3%); n = 16(9.4%); n = 8(4.7%); n = 5(2.9%) respectively. Disability scores on the DASH were 25.8 ± 14.5, 10.3 ± 11.9, and 10.6 ± 10.4 respectively for individuals with FS, LJM and Trigger Finger. DASH scores were highest in individuals with both CTS and FS, 29.8 ± 19.3. Duration of diabetes was significantly associated (r = 0 .19; P < .01) with the disability scores on DASH. CONCLUSION: The prevalence of musculoskeletal disorders in people with type 2 Diabetes mellitus remains high despite advances in medical management over the last two decades. The overall prevalence of hand disorders (LJM, CTS, Dupuytren's contracture, Trigger Finger) was higher than shoulder disorders (FS), e.g. frozen shoulder. People with a diabetes that had a diagnosed upper extremity conditon had more upper extremity disability, than those with diabetes but no diagnosed hand condition, Disability was highest for frozen shoulder and lowest for Dupuytren's diagnoses. Carpal tunnel syndrome was the most disabling hand condition. People with diabetes should be screened for upper extremity diagnoses that could limit their function. Poeple with disability resulting from hand disorders was lower than the shoulder disorders. A combination of hand and shoulder disorders resulted in greater disability.
Asunto(s)
Bursitis , Síndrome del Túnel Carpiano , Diabetes Mellitus Tipo 2 , Contractura de Dupuytren , Enfermedades Musculoesqueléticas , Trastorno del Dedo en Gatillo , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Estudios Transversales , Contractura de Dupuytren/diagnóstico , Contractura de Dupuytren/epidemiología , Contractura de Dupuytren/complicaciones , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/complicaciones , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/epidemiología , Extremidad Superior , Bursitis/complicaciones , Encuestas y Cuestionarios , Evaluación de la DiscapacidadRESUMEN
Frozen shoulder is a painful condition that often requires surgery and affects up to 5% of individuals aged 40-60 years. Little is known about the causes of the condition, but diabetes is a strong risk factor. To begin to understand the biological mechanisms involved, we aimed to identify genetic variants associated with frozen shoulder and to use Mendelian randomization to test the causal role of diabetes. We performed a genome-wide association study (GWAS) of frozen shoulder in the UK Biobank using data from 10,104 cases identified from inpatient, surgical and primary care codes. We used data from FinnGen for replication and meta-analysis. We used one-sample and two-sample Mendelian randomization approaches to test for a causal association of diabetes with frozen shoulder. We identified five genome-wide significant loci. The most significant locus (lead SNP rs28971325; OR = 1.20, [95% CI: 1.16-1.24], p = 5x10-29) contained WNT7B. This variant was also associated with Dupuytren's disease (OR = 2.31 [2.24, 2.39], p<1x10-300) as were a further two of the frozen shoulder associated variants. The Mendelian randomization results provided evidence that type 1 diabetes is a causal risk factor for frozen shoulder (OR = 1.03 [1.02-1.05], p = 3x10-6). There was no evidence that obesity was causally associated with frozen shoulder, suggesting that diabetes influences risk of the condition through glycemic rather than mechanical effects. We have identified genetic loci associated with frozen shoulder. There is a large overlap with Dupuytren's disease associated loci. Diabetes is a likely causal risk factor. Our results provide evidence of biological mechanisms involved in this common painful condition.
Asunto(s)
Bursitis/genética , Diabetes Mellitus/genética , Estudio de Asociación del Genoma Completo , Adulto , Bursitis/complicaciones , Complicaciones de la Diabetes/genética , Contractura de Dupuytren/complicaciones , Humanos , Análisis de la Aleatorización Mendeliana , Persona de Mediana Edad , Factores de Riesgo , Reino UnidoRESUMEN
We present the case of a severe and long-standing Dupuytren's contracture where intraoperatively an ossified nodule was encountered within the diseased tissue. Histologically palmar fibromatosis in contact with cartilaginous tissue with central ossification could be confirmed, compatible with metaplasia. Our finding suggests that metaplastic activity inherent to longstanding, severely diseased Dupuytren's tissue can lead to heterotopic ossification.
Asunto(s)
Contractura de Dupuytren/complicaciones , Osificación Heterotópica/complicaciones , Anciano , Contractura de Dupuytren/cirugía , Humanos , Masculino , Osificación Heterotópica/patología , Osificación Heterotópica/cirugíaRESUMEN
Dupuytren's disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England's Hospital Episode Statistics database and included all adult DD patients who were surgically treated. A longitudinal cohort study and self-controlled case series were conducted. Between 1 April 2007 and 31 March 2017, 121,488 adults underwent 158,119 operations for DD. The cumulative incidence of 90-day serious local complications was low at 1.2% (95% CI 1.1-1.2). However, the amputation rate for re-operation by limited fasciectomy following dermofasciectomy was 8%. 90-day systemic complications were also uncommon at 0.78% (95% CI 0.74-0.83), however operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications such as myocardial infarction. Re-operation was lower than previous reports (33.7% for percutaneous needle fasciotomy, 19.5% for limited fasciectomy, and 18.2% for dermofasciectomy). Overall, DD surgery performed in England was safe; however, re-operation by after dermofasciectomy carries a high risk of amputation. Furthermore, whilst serious systemic complications were unusual, the data suggest that high-risk patients should undergo treatment under local anaesthesia. These data will inform better shared decision-making regarding this common condition.
Asunto(s)
Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/cirugía , Adulto , Amputación Quirúrgica , Biometría , Estudios de Cohortes , Contractura de Dupuytren/etiología , Inglaterra/epidemiología , Fasciotomía/efectos adversos , Femenino , Mano/cirugía , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pacientes , Reoperación/efectos adversos , Proyectos de InvestigaciónRESUMEN
BACKGROUND: Dupuytren, Peyronie, and Ledderhose diseases are related fibroproliferative disorders characterized by abnormalities in the connective tissue of the palm of the hand, the tunica albuginea of the penis, and the sole of the foot, respectively. Concomitant prevalence rates of these diseases have only been described in a few small populations. This article aims to report on a large population and to raise awareness in surgeons treating Dupuytren disease for concurring related fibroproliferative disorders. METHODS: Patients diagnosed as having Dupuytren disease were recruited from outpatient clinics in the northern part of the Netherlands from 2007 to 2016. Questionnaires concerning demographics, clinical characteristics, the coexistence of Ledderhose and/or Peyronie diseases, and other factors were filled in by the participants and by plastic surgeons. RESULTS: For 730 men with Dupuytren disease, the surgeons' reported prevalence rate of Peyronie disease was 7.8 percent and of Ledderhose disease was 16.1 percent. The participants themselves reported prevalence rates of 8.8 percent for Peyronie disease and of 22.0 percent for Ledderhose disease. CONCLUSIONS: In the Dupuytren patient cohort, the prevalence of Peyronie disease was lower than that described in the literature. The prevalence of Ledderhose disease corresponded with the rates from the literature. However, both were underreported by plastic surgeons, which calls for a rise in awareness, recognition, and referral to a urologist when the conditions are bothersome or symptomatic.
Asunto(s)
Contractura de Dupuytren/complicaciones , Fibromatosis Plantar/complicaciones , Induración Peniana/complicaciones , Anciano , Contractura de Dupuytren/epidemiología , Femenino , Fibromatosis Plantar/epidemiología , Humanos , Masculino , Países Bajos/epidemiología , Induración Peniana/epidemiología , Prevalencia , Estudios ProspectivosRESUMEN
STUDY DESIGN: Qualitative descriptive. INTRODUCTION: Dupuytren's disease (DD) is a chronic hand condition causing impairment in hand function. Research describing persons' experiences of living with DD is limited. Understanding the subjective experience of illness is valuable for planning and implementing health-care services. PURPOSE OF THE STUDY: To explore experiences among men living with an impaired hand function due to DD and the consequences of the disease for daily activities. METHODS: Interviews were conducted with 21 men before surgery. The model of the patient evaluation process guided data collection. Data were analyzed using problem-driven content analysis. RESULTS: Participants described DD as a chronic disease caused by heredity, previous injury, hard work, or aging. DD was, according to the participants, an uncomfortable and sometimes painful condition, causing a feeling of constant stiffness in the affected hand. DD could cause participants to have fear of hurting the hand, feelings of shame or embarrassment, and a sense of being old. Participants handled the deteriorating hand function by avoiding or refraining from activities, adapting their performance, or performing activities with less quality. The ideal hand function was seen as being able to use the hands without effort. DISCUSSION: The diverse experiences of DD and if the hand is experienced as something that causes distress can be understood further using body-self dialectic and Gadow's states of embodiment, as well as the process of adapting and learning to live with the functional limitations. CONCLUSIONS: A clinical implication for hand therapy is to acknowledge patients' individual experiences and support self-modifications and development of new skills.
Asunto(s)
Actividades Cotidianas , Contractura de Dupuytren/fisiopatología , Contractura de Dupuytren/psicología , Mano/fisiopatología , Anciano , Anciano de 80 o más Años , Contractura de Dupuytren/complicaciones , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Calidad de Vida , Autoimagen , Factores SexualesRESUMEN
We report the case of a 71-year-old man with impaired left finger extension. The presence of nodular fibrosing lesions in his palm suggested Dupuytren contracture as the diagnosis. However, detailed neurological examination revealed muscle weakness associated with C7-Th1 lesions, and needle electromyography revealed denervation within the same distribution. Therefore, the patient was diagnosed with distal-type cervical spondylolisthesis muscular atrophy complicated with Dupuytren contracture. Due to shared symptoms with impaired finger extension, the other two conditions can be overlooked in patients affected by both diseases. Detailed clinical investigation of nodular fibrosing lesions, muscle weakness at the C7-Th1 level, and needle electromyography findings facilitate differential diagnosis of Dupuytren contracture and distal-type cervical spondylolisthesis. (Received June 24, 2019; Accepted September 17, 2019; Published November 1, 2019).
Asunto(s)
Contractura de Dupuytren/complicaciones , Enfermedades de la Médula Espinal/complicaciones , Espondilolistesis/complicaciones , Anciano , Vértebras Cervicales , Humanos , Masculino , Atrofia MuscularRESUMEN
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).
Asunto(s)
Colagenasas/uso terapéutico , Contractura de Dupuytren/terapia , Terapia por Ejercicio/métodos , Mano/fisiopatología , Férulas (Fijadores) , Adulto , Canadá , Niño , Terapia Combinada/métodos , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/fisiopatología , Edema/complicaciones , Edema/terapia , Femenino , Humanos , Masculino , Satisfacción del Paciente , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Autoinforme , Resultado del TratamientoRESUMEN
Aim To describe an uncommon clinical finding and raise awareness of its manifestation and associated conditions. Methods This case describes a gentleman with bilateral plantar fibromatosis caused by type 2 Diabetes Mellitus and previous alcohol excess. Results Treatment options include physiotherapy, steroid and collagenase injection therapy. Surgical intervention can be considered for persistently symptomatic or recurrent cases. Discussion In conclusion, plantar fibromatosis is an under-recognised and disabling condition which should prompt intervention and optimisation of co-morbidities.
Asunto(s)
Fibromatosis Plantar/diagnóstico , Alcoholismo/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/diagnóstico , Fibromatosis Plantar/complicaciones , Infecciones por VIH/complicaciones , Hepatitis C Crónica/complicaciones , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: Dupuytren's disease is a common and disabling condition. Its pathophysiology is not well understood. Some patients complain of postoperative loss of fingertip sensitivity that could be due either to the surgery or to the disease itself. Our hypothesis is that distal sensory disorders are a component of Dupuytren's disease. METHODS: We performed a prospective, single-center study to compare two populations: controls and patients with Dupuytren's disease. Subjects were excluded if they were under 18 years of age or had any disease or treatment that could alter finger sensitivity or test comprehension. Sensitivity was determined using Weber's static two-point discrimination test. Each ray of the tested hand in the Dupuytren's patients was classified as healthy or diseased; the diseased rays were graded using the Tubiana stages and the type of involvement (pure digital, pure palmar, palmar-digital). RESULTS: The study enrolled 56 patients in two comparable groups of 28 patients and 28 controls. A statistically significant difference was found between the affected hands of Dupuytren's patients and the hands of the controls. There was also a significant difference in the mean sensitivity of affected and normal rays in the Dupuytren's patients. CONCLUSION: Preoperative distal sensory disorders are a component of Dupuytren's disease that could be related to neuropathy and/or mechanical nerve compression. LEVEL OF EVIDENCE: IV, case-control study, diagnostic study.
Asunto(s)
Contractura de Dupuytren/complicaciones , Trastornos de la Sensación/etiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Dedos , Humanos , Masculino , Persona de Mediana Edad , Presión , Estudios Prospectivos , TactoRESUMEN
BACKGROUND: Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome and Dupuytren's contracture results in an increased incidence of complex regional pain syndrome. As a result, many surgeons do not perform surgery for the two conditions concurrently. The authors' goal was to determine the extent of this association. METHODS: The authors identified all patients undergoing surgical treatment for carpal tunnel syndrome, Dupuytren's contracture, or both between April of 1982 and March of 2017 using the Indiana Network for Patient Care, a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year postoperative incidence of complex regional pain syndrome were recorded. RESULTS: A total of 51,739 patients (95.6 percent) underwent carpal tunnel release only, 2103 (3.9 percent) underwent palmar fasciectomy only, and 305 (0.6 percent) underwent concurrent carpal tunnel release and palmar fasciectomy. There was no difference in the likelihood of developing complex regional pain syndrome (p = 0.163) between groups. Independent risk factors for developing complex regional pain syndrome were younger age; anxiety; depression; epilepsy; gout; and history of fracture of the radius, ulna, or carpus. CONCLUSIONS: Concurrent carpal tunnel release and palmar fasciectomy is not associated with an increased risk for developing complex regional pain syndrome. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of complex regional pain syndrome after surgery and should be discussed preoperatively as potential risk factors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Asunto(s)
Síndrome del Túnel Carpiano/cirugía , Síndromes de Dolor Regional Complejo/etiología , Contractura de Dupuytren/cirugía , Fasciotomía/efectos adversos , Síndrome del Túnel Carpiano/complicaciones , Contractura de Dupuytren/complicaciones , Fasciotomía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Advanced glycation end products are associated with aging, hyperglycemia, and oxidative stress. Accumulation of advanced glycation end products can cause various pathological conditions; however, the association of Dupuytren's disease with advanced glycation end products has not been demonstrated yet. The aim of this study is to investigate the association of Dupuytren's disease with advanced glycation end products. METHODS: Normal palmar fascia from five patients with carpal tunnel syndrome (control group) and Dupuytren's cords from five patients (Dupuytren's disease group) were harvested. The tissues were stained using an anti-advanced glycation end products antibody, anti-receptor for advanced glycation end products antibody, and an anti-reactive oxygen species modulator 1 antibody. The expression of nicotinamide adenine dinucleotide phosphate oxidase-1 and nicotinamide adenine dinucleotide phosphate oxidase-4 genes was also assessed using real-time PCR. For in vitro analysis, the cells harvested from the control and Dupuytren's disease groups were used. After 3 days of exposure to four types of media (control group, control + advanced glycation end products group, Dupuytren's disease group, Dupuytren's disease + advanced glycation end products group), superoxide detection reagent was detected using a total reactive oxygen species/superoxide detection kit. RESULTS: Immunostaining of the palmar fasciae of the Dupuytren's disease group showed higher expressions of advanced glycation end products and receptor for advanced glycation end products than that in the control group. The expression of nicotinamide adenine dinucleotide phosphate oxidase oxidase-1 and nicotinamide adenine dinucleotide phosphate oxidase-4 as well as reactive oxygen species modulator 1, an oxidatively damaged protein, was also higher in the Dupuytren's disease group than in the control group. In an in vitro cell culture, the addition of advanced glycation end products to the Dupuytren's disease-derived cells produced more superoxide free radicals. CONCLUSIONS: These data suggest that the advanced glycation end products receptor for advanced glycation end products interaction produced free radicals via nicotinamide adenine dinucleotide phosphate oxidase activation in Dupuytren's disease patients. Further studies are required to confirm these results.
Asunto(s)
Síndrome del Túnel Carpiano , Contractura de Dupuytren , Productos Finales de Glicación Avanzada , Síndrome del Túnel Carpiano/complicaciones , Técnicas de Cultivo de Célula , Contractura de Dupuytren/complicaciones , Contractura de Dupuytren/metabolismo , Fascia , Productos Finales de Glicación Avanzada/metabolismo , HumanosRESUMEN
Pseudo-boutonniere deformity is an uncommon complication from long-standing proximal interphalangeal (PIP) joint contracture in Dupuytren disease. Prolonged flexion contracture of the PIP joint can lead to central slip attenuation and resultant imbalances in the extensor mechanism. We present a technique of flexor digitorum superficialis (FDS) tendon transfer to the lateral bands to correct pseudo-boutonniere deformity at the time of palmar fasciectomy for the treatment of Dupuytren disease. The FDS tendon is transferred from volar to dorsal through the lumbrical canal and sutured into the dorsally mobilized lateral bands. This technique presents an approach to the repair of pseudo-boutonniere deformity in Dupuytren disease.
Asunto(s)
Contractura de Dupuytren/cirugía , Articulaciones de los Dedos/cirugía , Deformidades Adquiridas de la Mano/cirugía , Transferencia Tendinosa/métodos , Contractura de Dupuytren/complicaciones , Fasciotomía , Deformidades Adquiridas de la Mano/etiología , Humanos , Índice de Severidad de la EnfermedadAsunto(s)
Infarto Encefálico/diagnóstico por imagen , Contractura de Dupuytren/diagnóstico por imagen , Enfermedad Aguda , Infarto Encefálico/complicaciones , Contractura de Dupuytren/complicaciones , Mano , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Examen NeurológicoRESUMEN
AIM OF THE STUDY: The purpose of this study was to determine the recurrence rate, possible adverse reactions and factors influencing recurrence and progression of Dupuytren's disease (DD) treated with Collagenase from Clostridium histolyticum (CCH). METHOD: This was a prospective study of 71 patients with DD treated with CCH from 2011 to February 2013, with a minimum follow-up period of four years. Clinical, functional, patient satisfaction, drug safety and factors influencing recurrence and disease progression were evaluated. RESULTS: In all patients, the rupture of the cord was achieved after the injection, reducing joint contracture. In five patients (7%) we verified the existence of disease recurrence during the follow-up. In 11 patients (15.5%) there was a disease progression. Three patients have been surgically operated on, without added surgery difficulty; the rate of recurrence and progression was higher in grades III and IV of Tubiana, in proximal interphalangeal (PIP) punctures, and was earlier in patients younger than 60 years. DISCUSSION: No serious local complications or general complications were observed with this method. The recurrence of DD, following criteria of Felici, is mainly observed in young patients with greater severity of the disease and at the PIP level. Progression is influenced by the same factors. Patients operated on after recurrence have no added difficulty in the surgical technique, as it has also been published in other studies. CONCLUSIONS: Patients with the lowest rates of recurrence and progression were those with a single cord in the metacarpophalangeal (MCP), a grade II of Tubiana, and were older than 60 years.
Asunto(s)
Contractura de Dupuytren/terapia , Colagenasa Microbiana/efectos adversos , Procedimientos Ortopédicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Anciano , Progresión de la Enfermedad , Contractura de Dupuytren/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Colagenasa Microbiana/uso terapéutico , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Satisfacción del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: To determine the incidence of complex regional pain syndrome (CRPS) in the concurrent surgical treatment of Dupuytren contracture (DC) and carpal tunnel syndrome (CTS) through a thorough review of evidence available in the literature. METHODS: The indices of 260 hand surgery books and PubMed were searched for concomitant references to DC and CTS. Studies were eligible for inclusion if they evaluated the outcome of patients treated with simultaneous fasciectomy or fasciotomy for DC and carpal tunnel release using CRPS as a complication of treatment. Of the literature reviewed, only 4 studies met the defined criteria for use in the study. Data from the 4 studies were pooled, and the incidence of recurrence and complications, specifically CRPS, was noted. RESULTS: The rate of CRPS was found to be 10.4% in the simultaneous treatment group versus 4.1% in the fasciectomy-only group. This rate is nearly half the 8.3% rate of CRPS found in a randomized trial of patients undergoing carpal tunnel release. CONCLUSIONS: Our analysis demonstrates a marginal increase in the occurrence of CRPS by adding the carpal tunnel release to patients in need of fasciectomy, contradicting the original reports demonstrating a much higher rate of CRPS. This indicates that no clear clinical risk is associated with simultaneous surgical treatment of DC and CTS. In some patients, simultaneous surgical management of DC and CTS can be accomplished safely with minimal increased risk of CRPS type 1.