DUPUYTREN DISEASE MUDr Drahomr Palenr Ph D MUDr

DUPUYTREN DISEASE MUDr. Drahomír Palenčár, Ph. D. MUDr. Ivan Hulín

Characteristic Pathologic findings in palmar aponeurosis Fibrotic nodules and bands – superficial from tendons and nerovascular structures Secundar flections of MCP a PIP joints 1831 marquise Guillaume Dupuytren (17771835)

Ethiology, Pathofysiology Not clear The role of myofibroblasts Higher amount of colagen type I. Luck classification: � 1. proliferative fasis � 2. involution fasis (usporiadanie v smere ťahu) � 3. rezidual fasis (acelulárny vzhľad) Nowadays we think it is proliferative and mechanical process. The role of cytikynes – stimuls for fibroblasts

Incidence Europe. Kelts China and Africa low incidence Decreasing from north to south of Europe (Viking´s disease) Ratio male : female = 7, 5 : 1 Incidence is increasing with age Geografic difference (maximum Australia, France, Scotland, Ireland – 17% Other parts of body – plantar (Ledderhose), IPP

Clinical course Simple classification � 1. palmar form � 2. fingers form � 3. finger-palmar form � Tubiana classification � N – nodules and bands � N 1 – 5 degree contracture � Stage 1 – 4 (severe contracture on one finger at least)

Degree of contracture Clinical signs N 0 Nodules and bands N/1 0 -5 Mild contracture 1 6 -45 2 46 -90 3 91 -135 4 More than 135 Stage

Treatment and indications Collagenase � Tubiana 1 and 2 Needle aponeurotomy � Tubiana 1 and 2, or 3 -4 before operation Surgical aponeurectomy Tubiana N, N/1 no treatment Rehabilitation is very important

Treatment N N/1 1 2 3 4 Collagenase ++ ++ Needle aponeurotomy + ++ ++ + + Surgical aponeurectomy + ++ + relative indication ++ highly indicated

Complications Hematoma, infection, digital nerve injury, skin necrosis, hand swelling. Complications total - 19 % Algoneurodystrofic syndroma – 10 % (Sudeck syndr. )

THANK YOU