Tissue adaptation rate in the treatment of Dupuytren contracture.

STUDY DESIGN: Basic research (cross-sectional). INTRODUCTION: Dupuytren disease can cause disabling contractures of the finger joints. After partial fasciectomy, postoperative hand splinting helps to maintain extension range of motion. PURPOSE OF THE STUDY: To measure how the contraction forces of the finger on the splint change over time. METHODS: Subjects who were treated for Dupuytren contracture with partial fasciectomy were invited to participate in this study. Force sensors were placed in their dorsal extension splint, and the applied force was measured continually for several weeks. RESULTS: Eleven subjects (aged 59-75 years) with the metacarpophalangeal (8) or proximal interphalangeal (3) as their most severely affected finger joint participated. Each night, the measured force consistently decreased to reach a plateau after about 3 hour (adaptation time, 2.55; 95% confidence interval, 0.2-31.8 hours). The time to reach this plateau decreased with time after surgery (≈5%/day, P = .0005, R2 = 0.08). DISCUSSION AND CONCLUSIONS: The observed rate of decrease in the measured force indicates a tissue adaptation time of approximately 3 hours.

Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture.

STUDY DESIGN: This is a cross-sectional clinical measurement. INTRODUCTION: There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities. PURPOSE OF THE STUDY: The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO. METHODS: The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO. RESULTS: The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity. DISCUSSION: The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives. CONCLUSION: Further validation of the DIF-CHUM, including its scoring, is under way.

Experiences of men living with Dupuytren's disease-Consequences of the disease for hand function and daily activities.

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.

Ultrasound Features of Palmar Fibromatosis or Dupuytren Contracture.

OBJECTIVES: To retrospectively characterize the ultrasound appearance of palmar fibromatosis in patients with a surgical or clinical diagnosis of palmar fibromatosis. METHODS: A search of ultrasound reports from 2005 to 2015 and a subsequent search of medical records were performed to identify patients with a surgical or clinical diagnosis of palmar fibromatosis. The ultrasound images were retrospectively reviewed to record the lesion location, size, echogenicity, compressibility, hyperemia, and calcification. RESULTS: A total of 36 patients were identified (average age, 60 years; 61% male), yielding a total of 55 palmar fibromatosis lesions, of which 2%, 7%, 29%, 36%, 20%, and 5% were located at the first, second, third, fourth, and fifth digits and between the fourth and fifth digits, respectively. The lesions were located directly superficial to the flexor tendons in 93% with their epicenters at the distal metacarpal in 89%. Average lesion dimensions were 13.1 mm in length, 6.8 mm in width, and 2.5 mm in depth. On ultrasound images, the lesions were characteristically hypoechoic (98%) and noncompressible (95%). Atypical features included calcification (2%), compressibility (5%), hyperemia on color Doppler images (6%), epicenters at the metacarpophalangeal joint (7%) or proximal phalanx (4%), and location superficial but lateral to the flexor tendons (7%). CONCLUSIONS: Palmar fibromatosis most commonly appears hypoechoic and is located directly superficial to the flexor tendons with an epicenter at the distal metacarpal, most commonly the fourth digit. However, the epicenter location may be at the distal metacarpal and proximal phalanx of other digits, adjacent to the flexor tendons, with possible hyperemia and calcification.

Hand therapy or not following collagenase treatment for Dupuytren's contracture? Protocol for a randomised controlled trial.

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).

Variability of PROMIS Scores Across Hand Conditions.

PURPOSE: This study aimed to determine whether Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function and Pain Interference scores varied at presentation for specialty care by nontrauma hand condition. The secondary aim was to compare PROMIS scores with a reference standard, the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH), regarding the magnitude and direction of score differentials among diagnoses. METHODS: PROMIS Physical Function and Pain Interference scores were analyzed from 1,471 consecutive new adult patient clinic visits at a tertiary orthopedic hand clinic presenting with 1 of 5 nontrauma hand conditions. A 5-point difference on PROMIS assessments was presumed to be clinically relevant. A random sample of 30 QuickDASH scores from each diagnostic group was evaluated for score differentials among groups. We also measured the correlation between PROMIS and QuickDASH scores. RESULTS: Patients with carpal tunnel syndrome and thumb basal joint arthritis reported worse physical function and more pain interference, whereas those with Dupuytren contractures and ganglion cysts reported less pain and better function. For both domains, patients with trigger fingers averaged PROMIS scores among the other groups. Similar differences were observed in QuickDASH scores because patients with carpal tunnel syndrome and thumb arthritis reported clinically worse upper-extremity function than did patients with ganglion cysts and Dupuytren contracture. A strong correlation was seen between QuickDASH scores with both PROMIS Physical Function scores and Pain Interference scores. CONCLUSIONS: The PROMIS system is sufficiently able to capture differences in self-reported function and pain interference among patients with different hand conditions. Moreover, PROMIS Physical Function demonstrates construct validity when evaluated against a reference of the QuickDASH across nontrauma hand conditions. CLINICAL RELEVANCE: The use of PROMIS is expanding, but because PROMIS is not disease-specific, assessment of its construct validity is necessary for hand conditions.

Efficacy of collagenase Clostridium histolyticum injection for Dupuytren's contracture in East-Asian population.

BACKGROUND: Treatment with injection of collagenase Clostridium histolyticum (CCH) has been recognized as an effective option for the Dupuytren's contracture (DC) in Europe and North America. However, there are no studies describing mid-term efficacy of CCH treatment in East-Asian population. The purpose of this study was to assess 2-year outcomes following CCH treatment in Japanese patients. METHODS: Twenty hands (28 joints) from 18 DC patients underwent CCH injection with manipulation according to the product specifications with 2-year follow-up. Patients were assessed for extension deficit on treated metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints before treatment, at 4 weeks and 2 years after the treatment. RESULTS: At 4 weeks after CCH treatment, contracture of treated joints significantly improved from the mean extension deficit of 45° before treatment to 3° for MCP joints, and from 41° to 14° for PIP joints (P < 0.001, <0.001, respectively). Improved contracture was maintained with 4° and 23° at 2 years after CCH treatment (P < 0.001, <0.05, respectively). Successful correction defined as ≤ 5° extension deficit was obtained in 14/16 MCP and 5/12 PIP joints at 4 weeks; of these, 11 MCP and 1 PIP joints maintained the corrected range of motion at 2-year follow-up. CONCLUSION: CCH treatment could be a useful option to improve contracture in Japanese patients. During 2-year follow-up, this treatment could provide comparable effect durability to previous studies from Western countries. Moreover, our results support the evidence that better correction of the contracture can be obtained in the MCP joints than PIP joints after CCH treatment.

Short-term efficacy and safety of collagenase injection for Dupuytren's contracture: Therapy protocol for successful outcomes in a clinical setting.

PURPOSE: To assess the short-term efficacy and safety of collagenase injection for Dupuytren's contracture and of our post-injection therapy protocol alternative the instruction of phase III studies at clinical setting. METHODS: The retrospective study included 23 fingers of 21 hands of 18 patients for primary metacarpophalangeal (MP) joints and 11 fingers of 10 hands of 10 patients for primary proximal interphalangeal (PIP) joints with Dupuytren's contracture who were treated with 0.58 mg collagenase Clostridium histolyticum (CCH) injections at our hospital consecutively from September 2015 to October 2017. The mean age of the patients was 73.0 years (range, 57-88) for primary MP joints and 70.7 years (61-81) for primary PIP joints. Following standard CCH injection and manipulation on the next day, certified hand surgeons evaluated and treated each patient based on a defined 4-week therapy protocol that consisted of performing finger exercises during the day and wearing static extension splint at night for all cases, and of wearing Capener dynamic splint intervention to address severely contracted PIP joints. We measured the degree of contracture at baseline, immediately, 4 weeks, and 12 weeks after the last manipulation. RESULTS: More improvement of contracture was seen in the MP joints than in the PIP joints. For the five fingers severely contracted and treated with Capener splint intervention, the mean passive PIP joint contracture was 62.0° at baseline, 21.0° immediately, further improved to 6.0° by 4 weeks, and maintained 8.0° by 12 weeks after the last manipulation. The adverse events were mild-to-moderate local reactions in the injected hand. CONCLUSIONS: The clinical efficacy and safety of CCH were confirmed in a clinical setting similar to phase III studies. The improvement of 4-week-intervention was maintained at 12 weeks after the last manipulation. Severely contracted PIP joints could benefit from Capener splint intervention.

Factors predicting the 1-year outcome of collagenase treatment for Dupuytren's disease.

INTRODUCTION: Several studies have investigated the clinical outcome after collagenase treatment for Dupuytren's disease in terms of range of motion of the affected finger. However, good objective clinical outcome defined by a small remaining flexion contracture does not necessarily translate into satisfactory patient-subjective hand function. The aim of the present study was to identify predictors of patient-reported as well as objective clinical outcome in patients 1 year after collagenase treatment for Dupuytren's disease. MATERIALS AND METHODS: Socio-demographic and disease-related data of 92 Dupuytren patients were collected prior to the intervention. Flexion contracture of the most affected finger was measured at baseline and 1 year after treatment. Patients also completed the brief Michigan Hand Outcomes Questionnaire (brief MHQ) before the intervention and at 1-year follow-up. First, univariate correlations using Pearson's correlation coefficient of the baseline variables with the two target variables were investigated. All variables with r > 0.35 were selected for a multivariate linear stepwise backwards regression model. RESULTS: The mean brief MHQ score increased between baseline (72 ± 14) and the 1-year follow-up (85 ± 15) (p ≤ 0.001) and baseline flexion contracture decreased from 76° (± 26) to 33° (± 31) (p ≤ 0.001). Higher hand function at baseline (R2 = 0.31) and less flexion contracture (R2 = 0.46) were identified as positive predictors for the outcome 1 year after collagenase treatment for Dupuytren's disease. Other variables such as age, gender, manual work and if the MCP or PIP joint was affected did not determine outcome in our patient series. CONCLUSIONS: Collagenase treatment resulted in considerable improvement in flexion contracture as well as patient-reported hand function at the 1-year follow-up. Clinicians can expect better outcome after collagenase infiltration in patients with less flexion contracture and in patients showing good initial self-reported hand function.

Collagenase injections for Dupuytren disease: 3-year treatment outcomes and predictors of recurrence in 89 hands.

Background and purpose - Few prospective studies have reported the long-term effect durability of collagenase injections for Dupuytren disease. We assessed the 3-year treatment outcome of collagenase injections and predictors of recurrence.Patients and methods - We conducted a single-center prospective cohort study. Indication for collagenase injection was palpable Dupuytren's cord and active extension deficit (AED) ≥ 20° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. From November 2012 through June 2013, we treated 86 consecutive patients (92 hands, 126 fingers). A hand therapist measured joint contracture before, 5 weeks, and 3 years after injection. The patients rated their treatment satisfaction. Primary outcome was proportion of treated joints with ≥ 20° AED worsening between the 5-week and 3-year measurements. We analyzed predictors of recurrence.Results - 3-year outcomes were available for 83 of the 86 patients (89 hands, 120 treated fingers). Between the 5-week and 3-year measurements, AED worsened by ≥ 20° in 17 MCP (14%) and 28 PIP (23%) joints. At 3 years, complete correction (passive extension deficit 0-5°) was present in 73% of MCP and 35% of PIP joints. Treatment of small finger PIP joint contracture, greater pretreatment contracture severity, and previous fasciectomy on the treated finger were statistically significant predictors of recurrence. Treatment satisfaction was rated as very satisfied or satisfied in 59 of 87 hands. No long-term treatment-related adverse events were observed.Interpretation - 3 years after collagenase injections for Dupuytren disease, improvement was maintained and treatment satisfaction reported in two-thirds of the treated hands, with no adverse events. Complete contracture correction was achieved in 3 of 4 MCP joints, but in only a third of the PIP joints.

Dupuytren's disease: limited fasciectomy, night splinting, and hand exercises-long-term results.

BACKGROUND: Dupuytren's contracture (DC) is a fibroproliferative disorder of palmar fascia that causes flexion contractures of one or more digits. There is currently no gold standard operative and postoperative protocol for reducing recurrence rates. We propose a combination of surgical intervention, night splinting, and home hand exercises as a treatment protocol. METHODS: Thirty patients were included in our study, diagnosed with DC Tubiana grade II-IV. Our treatment protocol was limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for eight weeks. The outcomes were recurrence, QuickDASH score, extension or flexion deficit, and grip strength. The mean follow-up was 4.9 years (range 2-11 years). RESULTS: Recurrence of DC occurred in two patients (7%), who had discontinued the use of the splint within two months postoperatively. All other patients had complied with the postoperative protocol. The mean QuickDASH score improved from 61.5 (SD 2.1) to 8.6 (SD 2) postoperatively (p < 0.001). Grip strength did not differ significantly in the operated hands (37.9 kg, SD 1.3) when compared to the healthy hands (40.2 kg, SD 1.3, p = 0.035). The recurrence was not significantly correlated either with the Tubiana grade (p = 0.7), or with the patients' age (p = 0.27). CONCLUSIONS: This study shows that limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for at least eight weeks, is a viable protocol which reduces the rates of recurrence of DC.

Examiners' influence on the measured active and passive extension deficit in finger joints affected by Dupuytren disease.

BACKGROUND: The most commonly reported outcome measure in Dupuytren disease is the extension deficit in finger joints. This study aimed to investigate the examiners' influence on the measured difference between active and passive extension deficit. METHODS: A prospective cohort study was conducted on 157 consecutive patients (81% men, mean age 70 years) scheduled for collagenase treatment for Dupuytren disease. Before injection, one of three experienced hand therapists measured active extension deficit (AED) and passive extension deficit (PED) in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the affected fingers using a hand-held metal goniometer. We included joints with ≥10° AED, and calculated mean AED and PED in MCP and PIP joints measured by each examiner. For adjusted analysis we used a mixed effects model to determine the relationship between the examiner and the AED-PED difference. RESULTS: For all 291 joints measured, mean AED was 46° (SD 21) and mean PED was 37° (SD 23). Mean difference between AED and PED measured by examiner 1 was 6° (SD 6), by examiner 2 was 9° (SD 9), and by examiner 3 was 12° (SD 9). The mixed effects model analysis showed that the identity of the examining therapist was a significant determinant of the AED-PED difference. CONCLUSIONS: In Dupuytren disease measurement of active and passive extension deficit in finger joint contractures may vary significantly between different examiners. This must be taken into consideration when designing clinical studies and comparing outcomes between studies.

Short-term effect of shockwave therapy, temperature controlled high energy adjustable multi-mode emission laser or stretching in Dupuytren's disease: a prospective randomized clinical trial.

Dupuytren's disease is a debilitating disease of the hand characterized by nodules on the surface of the palm with progressive loss of finger extension. The chosen forms of treatment are infiltrative and surgical. Conservative treatment could be useful but few studies have been carried out and these regarded mainly stretching exercises and thermo-therapy. To date, no study has analyzed the effects of biostimulation with shock-waves (SW) and high energy laser therapy [Temperature controlled High Energy Adjustable multi-mode emission Laser (THEAL)]. We recruited 45 patients, 32 males and 13 females (average age 63.4 years) affected by early or late stage Dupuytren's disease [33 metacarpophalangeal (MCP) joints, 12 proximal interphalangeal (PIP) joints]. We randomized the patients into three treatment groups: extracorporeal shockwave therapy (ESWT), THEAL and stretching exercises. Follow-ups were at the end of treatment (T1), after 1 month (T2), and after 3 months (T3). The three forms of treatment determined a progressive clinical-functional improvement. The pain relief was statistically significant for SW and THEAL at all follow-ups (FUs) (p

Dupuytren's Contracture: Current Treatment Methods.

BACKGROUND: Dupuytren's disease is a common benign fibromatosis of the palmar and digital fascia. The exact pathophysiology and epidemiology of this condition have not been entirely identified. Pathologic fibrous bands cause a flexion contracture of the metacarpal phalangeal joints and proximal interphalangeal joint. Treatment includes fasciectomy, needle fasciotomy, and enzymatic fasciectomy.

Collagenase clostridium histolyticum in Dupuytren's contracture: a systematic review.

INTRODUCTION: In the last few years, the use of collagenase clostridium histolyticum for management of Dupuytren's contracture has increased. The procedure of enzymatic fasciectomy has become popular because it is non-invasive, safe and fast to perform. SOURCES OF DATA: A systematic search was performed on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'Dupuytren collagenase' and 'Dupuytren clostridium histolyticum'. Forty-three studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. AREAS OF AGREEMENT: The use of collagenase clostridium histolyticum provides better outcomes in patients with mild-moderate joint contracture, with lower complications and side effects than open fasciectomy. Manipulation can be performed 2-7 days after the injection. The use of collagenase is cost-effective. AREAS OF CONTROVERSY: Most of the studies did not report patient-related outcomes. The role of dynamic splint has to be investigated with randomized clinical trials. GROWING POINTS: The shorter recovery time and the low incidence of serious or major adverse effects are the main advantages of this new technology. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a need to perform studies with longer follow-up because the recurrence rate seems to increase with time. Further investigations are necessary to assess whether it is safe and effective to inject two or more cords at the same time.

To remember: Radiotherapy - a successful treatment for early Dupuytren's disease.

Dupuytren's disease (DD) is a common fibroproliferative condition of the hand which tends to cause progressive digital flexion contracture. Therapeutic strategies to treat the disease include radiotherapy, injections of collagenase clostridium histolyticum, needle fasciotomy and extended surgical intervention dependent on involvement and duration of the disease. We have reviewed the literature with the aim to assess the conditions and effects of radiotherapy in DD. In early stages of the disease, radiotherapy resulted in regression of symptoms/a lack of progression found on average in 40% (range 10-85%)/81% (range 50-100%) of the patients with recurrence rates of only 12-31% after long-term follow-up (>4 years). These results proved to be significantly better than in the untreated patients with natural course of the disease (about 50% progression after a follow-up of 5-6 years). Long-term side-effects (skin dryness) are observed on average in one quarter of the patients, but are well tolerated. Local occurrence of malignancies has not been reported yet. Due to severe functional impairment leading to individual suffering and the high economic burden, treatment of DD in early stages is necessary and radiation therapy represents an effective, safe and economic treatment option.

Unraveling the signaling pathways promoting fibrosis in Dupuytren's disease reveals TNF as a therapeutic target.

Dupuytren's disease is a very common progressive fibrosis of the palm leading to flexion deformities of the digits that impair hand function. The cell responsible for development of the disease is the myofibroblast. There is currently no treatment for early disease or for preventing recurrence following surgical excision of affected tissue in advanced disease. Therefore, we sought to unravel the signaling pathways leading to the development of myofibroblasts in Dupuytren's disease. We characterized the cells present in Dupuytren's tissue and found significant numbers of immune cells, including classically activated macrophages. High levels of proinflammatory cytokines were also detected in tissue from Dupuytren's patients. We compared the effects of these cytokines on contraction and profibrotic signaling pathways in fibroblasts from the palmar and nonpalmar dermis of Dupuytren's patients and palmar fibroblasts from non-Dupuytren's patients. Exogenous addition of TNF, but not other cytokines, including IL-6 and IL-1ß, promoted differentiation into specifically of palmar dermal fibroblasts from Dupuytren's patients in to myofibroblasts. We also demonstrated that TNF acts via the Wnt signaling pathway to drive contraction and profibrotic signaling in these cells. Finally, we examined the effects of targeted cytokine inhibition. Neutralizing antibodies to TNF inhibited the contractile activity of myofibroblasts derived from Dupuytren's patients, reduced their expression of α-smooth muscle actin, and mediated disassembly of the contractile apparatus. Therefore, we showed that localized inflammation in Dupuytren's disease contributes to the development and progression of this fibroproliferative disorder and identified TNF as a therapeutic target to down-regulate myofibroblast differentiation and activity.

Clusters in Short-term Disease Course in Participants With Primary Dupuytren Disease.

PURPOSE: The course of Dupuytren disease (DD) is thought to be progressive; however, the course differs for each patient. The purpose of this study was to study the rate and pattern of progression of DD. METHODS: We prospectively analyzed the course of DD at intervals of 3 to 6 months in 247 Dutch participants with primary DD by measuring the surface area of nodules and cords and the total passive extension deficit. The association between surface area and Tubiana stage was tested with generalized estimating equations. Latent class models were used to study different clusters in changes regarding the course of the disease. RESULTS: The variance in disease course between participants was large. Regarding the change in surface area (in all fingers) and total passive extension deficit (in the ring and little finger), different clusters were observed. Progression of disease was seen but there were also signs of stability and even regression. Patients with a smaller surface area at baseline were more likely to exhibit regression. CONCLUSIONS: This study showed that DD is not always progressive and that up to 75% of patients have a different short-term disease course, such as stability or even regression of disease. This should be taken into account when evaluating the effects of treatment for early-phase DD and in the design of future studies. Furthermore, this information may be useful when counseling patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Treatment of proximal interphalangeal joint flexion contracture: combined static and dynamic orthotic intervention compared with other therapy intervention: a randomized controlled trial.

PURPOSE: To test the effectiveness of static and dynamic orthoses using them as an exclusive treatment for proximal interphalangeal (PIP) joint flexion contracture compared with other hand therapy conservative treatments described in the literature. METHODS: 60 patients who used orthoses were compared with a control group that received other hand therapy treatments. Clinical assessments were measured before the experiment and 3 months after and included active PIP joint extension and function. RESULTS: A significant improvement in the extension active range of motion at the PIP joint in the second measurement was found in both groups, but it was significantly greater in the experimental group. Improvement in function (Disabilities of the Arm, Shoulder, and Hand score) between the first and second assessment was similar in the control and experimental groups. CONCLUSIONS: Using night progressive static and daily dynamic orthoses as an exclusive treatment during the proliferative phase led to significant improvements in the PIP joint active extension, but the improvement did not correlate with increased function as perceived by the patient. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. PURPOSE OF THE STUDY: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. METHODS: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). RESULTS: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. DISCUSSION: Safety and social issues of hand function and quality of life had an evident association with functional recovery. LEVEL OF EVIDENCE: IV.