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1.
Math Biosci Eng ; 19(3): 2876-2895, 2022 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-35240811

RESUMO

In this study we review the current state of the art for Dupuytren's disease (DD), while emphasising the need for a better integration of clinical, experimental and quantitative predictive approaches to understand the evolution of the disease and improve current treatments. We start with a brief review of the biology of this disease and current treatment approaches. Then, since certain aspects in the pathogenesis of this disorder have been compared to various biological aspects of wound healing and malignant processes, next we review some in silico (mathematical modelling and simulations) predictive approaches for complex multi-scale biological interactions occurring in wound healing and cancer. We also review the very few in silico approaches for DD, and emphasise the applicability of these approaches to address more biological questions related to this disease. We conclude by proposing new mathematical modelling and computational approaches for DD, which could be used in the absence of animal models to make qualitative and quantitative predictions about the evolution of this disease that could be further tested in vitro.


Assuntos
Contratura de Dupuytren , Animais , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/etiologia , Contratura de Dupuytren/terapia , Projetos de Pesquisa , Cicatrização
2.
Lasers Med Sci ; 37(1): 323-333, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33483776

RESUMO

Dupuytren's disease is a progressive fibroproliferative disorder of the hand. In the nodular stage of Dupuytren's disease, pain might limit daily hand activities and progress to finger contractures. Focused electromagnetic high-energetic extracorporeal shockwave therapy (ESWT) may reduce pain in Dupuytren's nodules (Tubiana N). In this prospective, randomized, blinded, placebo-controlled single center trial, we enrolled 52 patients (mean age, 58.2 ± 9.2) with painful nodular Dupuytren disease Tubiana N. Randomization was done to either (group A) 3 treatments with focused electromagnetic high-energetic ESWT (2000 shots, 3 Hz, 0.35 mmJ/mm2/hand, Storz Duolith SD1, n = 27) or (group B) placebo ESWT (2000 shots, 3 Hz, 0.01 mJ/mm2/hand, n = 25) in a weekly interval. Primary outcome was the level of pain on a visual analogue scale (VAS 0-10) at 3/6/12/18 months, secondary outcomes were patient-related outcome measures (DASH score, MHQ score, URAM scale), grip strength, patient's satisfaction, and Dupuytren's disease progression over 18 months follow-up. Focused ESWT significantly improved outcomes. Pain was reduced from 3.6 ± 1.8 to 1.9 ± 1.2 at three, to 1.4 ± 0.7 at six, to 1.7 ± 1.6 after 12 months and 1.9 ± 0.8 after 18 months in the intervention group (47% reduction, p < 0.05). In the placebo group, pain on VAS increased from 2.2 ± 1.4 to 3.4 ± 1.7 at three, to 3.4 ± 1.8 at six, to 3.4 ± 1.4 at 12 and 3.1 ± 1.1 at 18 months (35% increase, p < 0.05). Quality-of-life score tended to improve in the intervention group (MHQ, 77 ± 19 to 83 ± 12; DASH, 12 ± 18 to 10 ± 9) while it deteriorated in the placebo group as Dupuytren's disease was progressing (MHQ, 79 ± 15 to 73 ± 17; DASH, 6 ± 10 to 14 ± 13). The strength of the affected hand and fingers did not change significantly in either of the groups. Patients' satisfaction was higher in the intervention group for symptom improvement (56% vs. 12%) and reduction of disease progression (59% vs. 24%). Any Dupuytren-related intervention was performed in 26% in the intervention group and in 36% in the placebo group within 18 months of follow-up (n.s.). Focused electromagnetic high-energetic ESWT can significantly reduce pain in painful nodules in Dupuytren's disease in an 18-month perspective. ( ClinicalTrials.gov Identifier: NCT01184586).


Assuntos
Contratura de Dupuytren , Ondas de Choque de Alta Energia , Idoso , Contratura de Dupuytren/terapia , Fenômenos Eletromagnéticos , Ondas de Choque de Alta Energia/uso terapêutico , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Estudos Prospectivos
3.
J Hand Surg Am ; 46(10): 896-906, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34452797

RESUMO

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.


Assuntos
Contratura de Dupuytren , Contratura de Dupuytren/terapia , Fasciotomia , Mãos , Humanos , Colagenase Microbiana/uso terapêutico , Resultado do Tratamento
5.
J Hand Surg Asian Pac Vol ; 26(2): 131-141, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33928844

RESUMO

Dupuytren disease (DD) is a fibroproliferative disorder that originates at the palmar fascia and results in flexion contracture of the digits. The gold standard treatment for DD has been surgery. Surgical treatment of DD can be done with various methods, from percutaneous needle fasciotomy to dermatofasciectomy. The most commonly used surgical treatment is limited fasciectomy (LF). The potential complications of limited fasciectomy include long recovery time, scarring, neurovascular injury, and tendon injury. Minimally invasive treatment for DD, which is simple and allows for rapid return of function, has gained popularity amongst both patients and surgeons. Currently, minimally invasive treatments for DD include percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH). In this review, we provide an overview of the minimally invasive treatments for Dupuytren disease and summarize the current evidence regarding these minimally invasive treatments.


Assuntos
Contratura de Dupuytren/terapia , Contraindicações de Procedimentos , Fasciotomia , Humanos , Injeções , Colagenase Microbiana/uso terapêutico , Agulhas , Avaliação de Resultados da Assistência ao Paciente
6.
Knee ; 29: 190-200, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33640618

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is a successful treatment for patients with late stage osteoarthritis, yet arthrofibrosis remains a consistent cause of TKA failure. Dupuytren's, Ledderhose and Peyronie's Diseases are related conditions of increased fibroblast proliferation. The aim of this study was to identify whether an association exists between these conditions and arthrofibrosis following TKA. METHODS: Patient records were queried from 2010 to 2016 using an administrative claims database to compare the rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with independent chart diagnoses of Dupuytren's Contracture, Ledderhose, or Peyronie's Diseases versus those without. Complications were queried and compared using multivariate logistic regression. RESULTS: Patients with Dupuytren's (n = 5,232) and Ledderhose (n = 50,716) had a significantly higher rate of ankylosis following TKA: 30-days (OR, 1.54; OR, 1.23), 90-days (OR, 1.20; OR, 1.24), 6-months (OR, 1.23; OR, 1.23), and 1-year (OR, 1.28; OR, 1.23), while patients with Peyronie's (n = 1,186) had a higher rate of diagnosis at 6-months (OR, 1.37) and 1-year (OR, 1.35). Patients with diagnoses of any of the fibroproliferative diseases had a statistically higher risk of MUA at 90-days, 6-month, and 1-year following primary TKA. These cohorts did not have a significantly higher rate of revision TKA. CONCLUSION: There is an increased odds risk of arthrofibrosis and MUA in patients who have undergone TKA and have a diagnosis of Dupuytren's Contracture, Ledderhose, or Peyronie's Diseases. Improvements to frequency and application of post-operative treatment should be considered in these cohorts to improve outcomes.


Assuntos
Artroplastia do Joelho/efeitos adversos , Contratura de Dupuytren/fisiopatologia , Fibromatose Plantar/fisiopatologia , Artropatias/etiologia , Induração Peniana/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Anquilose/etiologia , Contratura de Dupuytren/terapia , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de Risco
8.
J Hand Ther ; 34(3): 446-452, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32307236

RESUMO

INTRODUCTION: Patient-reported outcome measures have become the standard tool for reflecting the patient's perspective on their treatment outcome for a wide variety of hand conditions. The Patient-Specific Functional Scale (PSFS), is an individualized questionnaire that enables patients to specify those activities with which they have difficulty in daily life. PURPOSE OF THE STUDY: This study aims to determine the content validity and responsiveness of the PSFS compared with the Michigan Hand Questionnaire (MHQ) in patients with Dupuytren's disease. STUDY DESIGN: Multicentre inception cohort. METHODS: Patients with Dupuytren's disease being treated with percutaneous needle aponeurotomy, limited fasciectomy, or skin graft were selected from a database with routine outcome measurements in usual care. To assess content validity of the PSFS, the activities specified by patients were classified into the International Classification of Function core set for hand conditions. The standardized response mean is calculated for the pre- and post-change scores of the PSFS to evaluate responsiveness. RESULTS: Three hundred and eight patients were analyzed before and three months after treatment. Content validity of the PSFS was appropriate because 95% of all items could be classified into the International Classification of Function activities and participation domain. The standardized response mean of the PSFS was 1.0 (95% confidence interval, 0.86-1.2), which was substantially larger than the standardized response mean of the MHQ score 0.58 (95% confidence interval, 0.42-0.74). DISCUSSION: The PSFS is a content-valid questionnaire which may be more responsive to change than a fixed-item instrument such as the MHQ in patients with Dupuytren's disease. CONCLUSIONS: The PSFS is a valuable tool to set therapy goals and evaluate the progress over time in patients with Dupuytren's disease.


Assuntos
Contratura de Dupuytren , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/terapia , Fasciotomia , Mãos , Humanos , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
9.
Expert Rev Pharmacoecon Outcomes Res ; 21(1): 127-136, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32408788

RESUMO

Background: We conducted a comparative assessment of the productivity loss associated with the two different treatment options for Dupuytren's disease: collagenase and fasciectomy. Methods: The retrospective claims analysis was performed using the data from IBM MarketScan® Commercial (CD) and Health and Productivity Management (HPM) Databases over five years (2012-2016). We identified two cohorts of patients who underwent either collagenase or fasciectomy in the CD. Propensity-score matched patients were linked to their productivity loss claims in the HPM database. Productivity loss measures were assessed over a 12-month follow-up period. Results: Out of 702 collagenase and 999 fasciectomy propensity score-matched patients in the CD, there were 147 collagenase and 273 fasciectomy patients in the HPM database. Over the follow-up period, collagenase-treated patients were significantly less likely to use short-term disability (STD) leave (9.7% vs. 20.2%; P = 0.009), reflecting in the lower average number of absent STD days (mean, 2.8 vs. 8.1; P = 0.002) in comparison to fasciectomy-treated. The mean indirect STD cost was considerably lower in the collagenase vs. fasciectomy group ($375 vs. $1,108; P = 0.002). Conclusion: This study indicates that collagenase vs. fasciectomy treatment may be related to a lower rate of workplace absence and lower indirect cost in a year following the treatment.


Assuntos
Colagenases/administração & dosagem , Contratura de Dupuytren/terapia , Fasciotomia/economia , Seguro Saúde/economia , Absenteísmo , Estudos de Coortes , Colagenases/economia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Contratura de Dupuytren/economia , Eficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
10.
J Plast Reconstr Aesthet Surg ; 74(7): 1621-1628, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33371958

RESUMO

BACKGROUND: In health care, quality-of-life surveys and questionnaires related to care are becoming increasingly important as a measure of its quality. There is currently no Spanish version of the Unité Rhumatologique des Affections de la Main (URAM) scale, which makes it suitable for hand pathology. The purposes of this study are to develop a Spanish version of the URAM and perform a transcultural adaptation of it, analyzing the result for reliability, validity, and sensitivity to changes. METHODS: The questionnaire was evaluated for patients with Dupuytren's disease and Carpal Tunnel Syndrome. The cohort study subjects were interviewed at three points in time (baseline, three days after intervention, and one month after), administering the QuickDASH, URAM, and SF-12 (CF12 = physical component, CM12 = mental component) questionnaires at baseline and after intervention; and only the URAM at 3 days. Content validity was evaluated using Cronbach's α. The distribution of the factorial loads of the items and the pattern of the answers were checked. Responsiveness was evaluated by the size of the effect and the reliable rate of change. Convergent and divergent validity was performed using Spearman's r between the different questionnaires. RESULTS: The study was conducted with 106 patients. The mean baseline scores were: URAM = 14.8, QuickDASH = 41.6, CF12 = 39.3 and CM12 = 49.4. Ceiling or floor effects were not observed in the Spanish URAM. The Cronbach α = 0.853 explains 49.6% of the variance. The study had a high reproducibility (intraclass correlation coefficient (ICC) = 0.939). Size effect, measured as differences in scores, was moderate for URAM (-0.69) and QuickDASH (-0.51); and low for CF12 and CM12. The correlation of URAM with QuickDASH was high (r = 0.716), and moderate with DD and CTS. CONCLUSION: The Spanish version of the URAM is a valid and reliable tool for use in assessing hand pathology.


Assuntos
Síndrome do Túnel Carpal/terapia , Contratura de Dupuytren/terapia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome do Túnel Carpal/diagnóstico , Assistência à Saúde Culturalmente Competente , Contratura de Dupuytren/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Espanha , Traduções , Adulto Jovem
11.
Rehabilitación (Madr., Ed. impr.) ; 54(4): 249-253, oct.-dic. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-200260

RESUMO

INTRODUCCIÓN: La enfermedad de Dupuytren es un trastorno fibroproliferativo de la aponeurosis palmar que conduce a contracturas de flexión digital. Esta afección incapacitante se puede tratar con un procedimiento mínimamente invasivo, llamado aponeurotomía percutánea con aguja (APA). OBJETIVO: Presentar los resultados de 10 años de experiencia en el tratamiento de la contractura de Dupuytren por APA en la Consulta de Mano Reumatológica de nuestro departamento. MÉTODOS: Se ha realizado un estudio retrospectivo con la descripción del método de ejecución de la APA junto con el análisis de los resultados posteriores al procedimiento. RESULTADOS: Se han observado un total de 197 pacientes con enfermedad de Dupuytren. Noventa y ocho pacientes (49,7%) fueron tratados con APA, lo que equivale a 117 dedos tratados. Hubo un 84% de buenos resultados inmediatos, con mejores resultados para las etapas menos avanzadas. Se observaron recurrencias en un 12% de los pacientes. Se registró una tasa de complicación del 1,7%. CONCLUSIÓN: Nuestros resultados confirman el valor de esta técnica especialmente en las primeras etapas de la enfermedad de Dupuytren, con resultados satisfactorios inmediatos asociados a una baja tasa de complicaciones


INTRODUCTION: Dupuytren's disease is a fibroproliferative disorder of the palmar aponeurosis that leads to digital flexion contractures. This disabling condition can be treated with a minimally invasive procedure, called percutaneous needle aponeurotomy (PNA). OBJECTIVE: To report the results of 10 years of experience treating Dupuytren's contracture by PNA in the rheumatology hand unit of our department. METHODS: We conducted a retrospective study with a description of method to perform PNA and analysis of post-procedure results. RESULTS: There were 197 patients with Dupuytren's disease. Ninety-eight patients (49.7%) underwent PNA, corresponding to 117 treated fingers. Good immediate results were achieved in 84% of the patients, with results being better in those with less advanced stages. Recurrences occurred in 12% of the patients. The complication rate was 1.7%. CONCLUSION: Our results confirm the value of this technique especially in the early stages of Dupuytren's disease, with immediate satisfactory results and a low rate of complications


Assuntos
Humanos , Contratura de Dupuytren/terapia , Aponeurose/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Estudos Retrospectivos , Eletroacupuntura/métodos , Resultado do Tratamento
12.
Rev. cuba. ortop. traumatol ; 34(2): e255, jul.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1156590

RESUMO

RESUMEN Introducción: La enfermedad de Dupuytren es una contractura de la fascia palmar debida a proliferación fibrosa, que provoca deformidades en flexión y pérdida de la función de los dedos de la mano. Puede también localizarse en las plantas de los pies, el pene y otras partes del cuerpo; un gran por ciento de los casos son de causa desconocida. Objetivos: Describir las variables sexo, enfermedades acompañantes, hábitos tóxicos y edad de los pacientes estudiados con la afección, e identificar las complicaciones relacionadas con la técnica quirúrgica aplicada. Métodos: Se realizó un estudio observacional descriptivo longitudinal en pacientes con enfermedad de Dupuytren, atendidos en el Hospital Carlos Manuel de Céspedes de Bayamo, en el período comprendido entre enero de 2018 y diciembre de 2019. La recolección de datos se realizó a través de las historias clínicas. La muestra fue de 67 pacientes atendidos en este periodo. Para la evaluación se utilizó el sistema de evaluación propuesto por Leuking Hung. Resultados: La enfermedad fue más frecuente en el sexo masculino y en el grupo de 51 a 60 años; se diagnostica más en fumadores, diabéticos y alcohólicos; los síntomas que más se presentaron fueron la presencia de cuerdas y nódulos; el tratamiento más utilizado fue la cirugía mediante zetaplastia; las infecciones en el sitio quirúrgico constituyeron la principal complicación. Conclusiones: En más del 73 por ciento de los pacientes tratados se obtuvieron resultados aceptables(AU)


ABSTRACT Introduction: Dupuytren's disease is a contracture of the palmar fascia due to fibrous proliferation, which causes flexion deformities and loss of function of the fingers of the hand. It can also be located on the soles of the feet, the penis and other parts of the body; a large percent of cases are of unknown cause. Objectives: To describe the variables sex, accompanying diseases, toxic habits and age of the patients studied with the condition, and to identify the complications related to the applied surgical technique. Methods: A longitudinal descriptive observational study was carried out in patients with Dupuytren's disease, treated at Carlos Manuel de Céspedes Hospital in Bayamo, from January 2018 to December 2019. Data collection was performed through the medical records. The sample consisted of 67 patients seen in this period. For the assessment, Leuking Hung´s evaluation system was used. Results: The disease was more frequent in males and in the group of 51 to 60 years. It is more diagnosed in smokers, diabetics and alcoholics; the most common symptoms were the presence of cords and nodules; zetaplasty surgery was the most used treatment. Surgical site infections were the main complication. Conclusions: In more than 73 percent of the treated patients, acceptable results were obtained(AU)


Assuntos
Humanos , Masculino , Feminino , Contratura de Dupuytren/terapia , Epidemiologia Descritiva , Estudos Longitudinais , Contratura de Dupuytren/epidemiologia , Estudo Observacional
13.
J Hand Surg Asian Pac Vol ; 25(4): 453-461, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33115367

RESUMO

Background: Management of Dupuytren Disease is variable, and influenced by multiple factors including location, extent of disease, surgical preference and familiarity with different treatment techniques. The objective of this study was to determine current Dupuytren Disease management trends in Australia. Methods: A questionnaire was sent through The Australian Hand Surgery Society to all members. In addition to demographic data, indications and preferences for different management interventions were surveyed on location of disease, age and activity level of the patient. Results: 99 (48%) of the Australian Hand Surgery Society members completed the survey. Respondents were primarily Orthopaedic (50%) or Plastic (49%) Surgeons, and most worked in private (99%) and public (71%) practice. Surgeon's believed that Tubiana's treatment goals to correct deformity was the most important (60%) and to shorten post-operative recovery (60%) was the least important. Only 42% of respondents perform needle aponeurotomy for Dupuytren Disease. In contrast 70% of respondents perform collagenase injections, with manipulation most commonly undertaken on the second day (46%) and skin tears (52%) the most common complication. Seventy-five percent of the respondents feel there is sufficient evidence to support the treatment of Dupuytren disease with collagenase injections. Ninety nine percent of all respondents perform fasciectomes for Dupuytren Disease, with Limited (without graft) (76%) the most routine performed. Conclusions: Several procedural options for the treatment of Dupuytren Disease exist within Australia. This study shows current Australian practice trends and highlights the increasing use of collagenase.


Assuntos
Contratura de Dupuytren/terapia , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Adulto , Idoso , Austrália , Clostridium histolyticum , Fasciotomia/estatística & dados numéricos , Humanos , Injeções/estatística & dados numéricos , Colagenase Microbiana/uso terapêutico , Pessoa de Meia-Idade , Agulhas , Inquéritos e Questionários
14.
Dan Med J ; 67(6)2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32741436

RESUMO

INTRODUCTION: A Danish validated patient-reported outcome measure (PROM) specific to Dupuytren's disease (DD) does currently not exist. Such a PROM would be useful in the assessment of DD patients. The aim of this study was to translate the Southampton Dupuytren's Scoring Scheme (SDSS) into Danish and validate the translated version of the PROM. METHODS: The SDSS was translated according to guidelines by Swaine-Verdier et al. A total of 110 patients diagnosed with DD completed the translated SDSS and evaluated the PROM. The severity of DD was assessed clinically using the Tubiana classification method. In all, 16 patients treated with collagenase injections were re-evaluated with the SDSS and the Tubiana post treatment. The reliability of the SDSS was tested in terms of internal consistency expressed as Cronbach's alpha and test-retest expressed by the intraclass correlation coefficient (ICC). Construct validation was calculated by Spearman's correlation coefficient between the SDSS and the Tubiana, and the responsiveness of the PROM was tested using point-biserial correlation and standardised response mean (SRM). RESULTS: Cronbach's alpha was 0.76 and an ICC of 0.82 (95% confidence interval (CI): 0.53-0.93, p less-than 0.0001). Spearman's correlation coefficient was 0.26 (95% CI: 0.08-0.43, p = 0.007) preoperatively and 0.39 (95% CI: -0.13-0.74, p = 0.14) post treatment. The SRM was 1.96 (95% CI: 1.42-2.48), and the point-biserial correlation coefficient was 0.52 (95% CI: 0.03-0.81, p = 0.039). CONCLUSIONS: The PROM shows good reliability, has substantial responsiveness to change and enjoys a high level of patient approval. The PROM is therefore recommended for patients with DD. FUNDING: none. TRIAL REGISTRATION: The study was reported to the Danish Data Protection Agency.


Assuntos
Contratura de Dupuytren/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Dinamarca , Avaliação da Deficiência , Contratura de Dupuytren/fisiopatologia , Contratura de Dupuytren/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Traduções
15.
Hand Surg Rehabil ; 39(6): 568-574, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32652250

RESUMO

We sought to investigate the reliability, validity, responsiveness, and interpretability of the German version of the Unité Rhumatologique des Affections de la Main (URAM) scale in patients with Dupuytren's disease. Patients with Dupuytren's disease were evaluated before receiving an injection of collagenase Clostridium histolyticum or undergoing surgical treatment and again 1 year later. Patients completed the URAM, the brief Michigan Hand Outcomes Questionnaire (brief MHQ), and the 5-level EuroQol version (EQ-5D-5L). Flexion contracture was measured. Internal consistency (Cronbach's alpha), construct validity (Spearman's correlation coefficient, r), responsiveness (effect size), and the minimally important change (MIC) and minimally important difference (MID) were determined. Confirmatory factor analysis was used to test the structural validity of the questionnaire. We included 231 patients (273 cases) with a mean age of 67 (SD, 9) years. Cronbach's alpha was 0.91. Correlations between the URAM and the brief MHQ, EQ-5D-5L and flexion contracture were r=-0.76, r=-0.46 and r=0.53, respectively. The URAM effect size was 0.96 and the MIC and MID were 6 and 7 points, respectively. The factor analysis revealed unidimensionality but indicated that one item (pick up small objects) could be removed. The German URAM has high reliability, good construct validity and excellent responsiveness. However, the questionnaire could be shortened by one item to increase its structural validity. We recommend using the URAM as a specific tool for evaluating the treatment effect in patients with Dupuytren's disease in daily practice and for research purposes.


Assuntos
Avaliação da Deficiência , Contratura de Dupuytren/terapia , Idoso , Feminino , Humanos , Injeções , Masculino , Colagenase Microbiana/uso terapêutico , Sistema de Registros , Reprodutibilidade dos Testes
16.
Medicine (Baltimore) ; 99(24): e20587, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541491

RESUMO

INTRODUCTION: While the efficacy of focused Extracorporeal Shock Wave Therapy (ESWT) in the treatment of Dupuytren's disease (DD) is supported by one positive trial, the effects of radial ESWT is unclear. PATIENT CONCERNS: A 79-year-old man with a 4-year history of impairment of left-hand function and pain due to DD with weakness and flexion deformities of middle and ring fingers. He has not been treated before for this impairment. DIAGNOSIS: The diagnosis of DD was based on clinical features and ultrasound images. INTERVENTIONS: Four weekly sessions of radial ESWT with 1400 impulses 3 bar each, 12 Hz. OUTCOMES: The limitations in activities of daily living were analyzed through the Disabilities of Arm Shoulder and Hand Questionnaire (DASH) and Michigan Hand Outcome Questionnaire (MHQ) at baseline, after four sessions of radial ESWT and at 4-months follow-up. Data analysis showed a significant reduction of hand deformities and an improvement of daily living performance. The effects continued at the 4-months follow-up. CONCLUSION: This case report demonstrates the feasibility of radial ESWT. Radial ESWT sessions may be carried out by a physiotherapist in outpatient clinics with cost reduction compared with surgical treatment and focused ESWT. Radial ESWT is a non-invasive, well tolerated therapy, so it should be considered in the DD treatment.


Assuntos
Contratura de Dupuytren/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Idoso , Humanos , Masculino
17.
Plast Reconstr Surg ; 145(6): 1464-1474, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459776

RESUMO

BACKGROUND: This study compared the effectiveness of injectable collagenase clostridium histolyticum and percutaneous needle fasciotomy in the treatment of Dupuytren's contracture. METHODS: Patients with a total passive extension deficit of 30 degrees or more in a single digital ray were enrolled and assigned randomly to receive either collagenase clostridium histolyticum injections or percutaneous needle fasciotomy. Preoperative severity of proximal interphalangeal joint contracture for Dupuytren's disease was classified according to the British Society for Surgery of the Hand as less than 30 degrees (stage I) or 30 degrees or more (stage II). RESULTS: Of the 70 patients enrolled, 36 patients with 46 joints received collagenase clostridium histolyticum injections and 34 patients with 48 joints received percutaneous needle fasciotomy. At day 30, successful corrections were obtained in only 50 percent of the injection group and 67 percent of the fasciotomy group for stage II proximal interphalangeal joints. Recurrences were frequent among patients with stage II joint contractures. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score at day 30 was significantly higher in the injection group compared with the fasciotomy group (7.5 versus 4.2, respectively). In the injection group, adverse events were reported for all patients. In the fasciotomy group, complications were reported for 15 percent of patients. CONCLUSIONS: The collagenase clostridium histolyticum and percutaneous needle fasciotomy groups had similar outcomes for Dupuytren's contracture with 3 years' follow-up. Recurrences were frequent among patients with stage II proximal interphalangeal joint contractures. The Unité Rhumatologique des Affections de la Main scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire score decreased significantly for both groups at final follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Contratura de Dupuytren/terapia , Fasciotomia/instrumentação , Colagenase Microbiana/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Idoso , Contratura de Dupuytren/fisiopatologia , Fasciotomia/efeitos adversos , Feminino , Articulações dos Dedos/fisiopatologia , Seguimentos , Mãos , Humanos , Injeções Intralesionais/efeitos adversos , Masculino , Colagenase Microbiana/efeitos adversos , Agulhas , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Recidiva , Resultado do Tratamento
18.
Hand Surg Rehabil ; 39(5): 448-453, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32380137

RESUMO

Long regarded as a disease exclusively found amongst Northern Europeans, Dupuytren's disease was seldom studied amongst Black Africans. Thus, we sought to study the impact of Dupuytren's disease, its etiological, clinical and evolutionary peculiarities on a segment of the Senegalese population. This study analyzed data derived from clinical observations carried out between January 2006 and December 2018. It involved Senegalese subjects with Dupuytren's disease, the patients' history, profession, habitus, clinical findings, therapeutic modalities and disease staging. The population included 20 men and 6 women averaging 63.5 years of age (range 45-77). None of the patients reported a family of Dupuytren's disease. Twelve patients had diabetes, 11 were smokers and 22 were engaged exclusively in manual labor. The condition was bilateral in 14 cases. Tubiana stages N, I, II, III and IV were found in 31, 15, 9, 5 and 6 rays, respectively. Conservative treatment was done in 11 patients. Surgical treatment was carried out in the other 15 patients: needle fasciotomy (N=10) including two bilateral involvement and open fasciectomy (N=7). Functional outcomes were satisfactory. Lesions were all stable in the short and medium term. Two patients had progressive lesions on a longer-term basis. Dupuytren's disease is real among Afro-descendants from Senegal even though it is seldom studied. Based on the patients' recollection of Dupuytren's disease in their families, heredity is not yet a proven factor. The early forms are more common, and the lesions remain stable for a long time.


Assuntos
Contratura de Dupuytren/etnologia , Contratura de Dupuytren/terapia , Idoso , Tratamento Conservador , Contratura de Dupuytren/classificação , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Senegal/epidemiologia
19.
Hand Surg Rehabil ; 39(4): 316-319, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32259595

RESUMO

Clostridiumhistolyticum collagenase (CHC) is rapidly becoming a mainstream treatment option for Dupuytren's disease for hand surgeons. We performed a retrospective study of the efficacy of this substance at a lower concentration, but a higher total dose than recommended by the manufacturer. Thirty-nine patients with 43 affected hands were treated and analyzed at a mean follow-up of 27 months. Subgroup analysis was done for patients who received treatment in one or two joints (group A), and for patients who received treatment in more than two joints (group B). We found that our CHC solution is safe and effective when simultaneously treating as many as four joints affected by Dupuytren's disease. Patients in group B had a lower (but non-significant) treatment failure rate compared to patients in group A. Also, higher satisfaction rates were observed in group B, again non-significant. No major complications were observed in any group. CHC use is associated with only minor complications. The results are consistent even when up to four joints are treated with one dose. LEVEL OF EVIDENCE: III.


Assuntos
Contratura de Dupuytren/terapia , Colagenase Microbiana/administração & dosagem , Progressão da Doença , Relação Dose-Resposta a Droga , Seguimentos , Humanos , Injeções , Satisfação do Paciente , Estudos Retrospectivos
20.
Hand (N Y) ; 15(1): 97-102, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30043624

RESUMO

Background: Indication for intervention in Dupuytren disease is influenced by many factors, including location and extent of disease, surgeon preference, and comfort level with different treatment techniques. The aim of this study was to determine current Dupuytren disease management trends. Methods: A questionnaire was sent through the American Society for Surgery of the Hand to all members. In addition to demographic data, questions focused on indications for different procedural interventions based on location of disease, age, and activity level of the patient. Results: Approximately 24% of respondents completed the survey. Respondents were mostly orthopedic surgeons in private practice who do not work with residents or fellows. Respondents preferred collagenase over needle aponeurotomy and limited fasciectomy for primary Dupuytren disease involving only the metacarpophalangeal (MCP) joint. Limited fasciectomy was the preferred treatment for primary Dupuytren disease involving the MCP and proximal interphalangeal joints. For a patient amenable to any treatment option, the majority would use collagenase, although 87.1% felt that fasciectomy offered the longest disease-free interval. Furthermore, given the option of a young, working patient, 42.7% would use collagenase, while plastic and general surgeons were more likely to treat this patient with limited fasciectomy. More plastic surgeons (vs orthopedic) believe that limited fasciectomy yields the longest disease-free interval. For a patient amenable to any surgical option, orthopedic surgeons prefer collagenase, whereas plastic hand surgeons prefer a limited fasciectomy. Conclusion: There are several procedural options for the treatment of Dupuytren disease. This study details current practice patterns among hand surgeons and reveals the increasingly prevalent use of collagenase.


Assuntos
Contratura de Dupuytren/terapia , Mãos/cirurgia , Cirurgiões Ortopédicos/estatística & dados numéricos , Padrões de Prática Médica/tendências , Adulto , Colagenases/uso terapêutico , Gerenciamento Clínico , Fasciotomia/tendências , Feminino , Humanos , Masculino , Articulação Metacarpofalângica/cirurgia , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento
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