Creteur V, Madani A, Gosset N. Ultrasound imaging of Dupuytren`s contracture. J. Radiol. 2010;91:687–91. Zachariae [33] injected hydrocortisone acetate into 9 patients (9 hands) with early DD, defined as non-contracture palmar fibrosis or total contracture of all joints with a number of 30° or less. Six patients received a total of 3 injections of 25 mg, 1 patient received 2 injections of 50 mg, 1 patient received 2 injections of 10 mg followed by an injection of 25 mg, and 1 patient was injected twice with 25 mg. All injections were given at intervals of 2 to 3 weeks over a period of 2 to 5 weeks. The follow-up period ranged from 2 to 24 months. The result was clinically assessed and fibrosis was subjectively reported as „decreased“, „slightly decreased“ or „softened“ in all cases, with pain resolution in both cases describing the pain at baseline. Recurrence at 14 months was reported in the patient who received two injections of 10 mg and one injection of 25 mg.
Larocerie-Salgado J, Davidson J. Non-surgical treatment of PIPJ bending contractures associated with Dupuytren`s disease. J Hand Surg Eur Vol. 2012;37:722–7. Dupuytren`s disease (DD) is a common fibroproliferative disease of the hand, affecting about 4% of the general population in the United Kingdom and the United States [1, 2]. The prevalence of DD in the general population increases with age and was estimated in a recent systematic review at 12% among 55-year-olds, and in the general population of Western countries at 29% in the general population [3]. The classic description of the course of the disease is the initial appearance of nodules with subsequent formation of cords. This is followed by a final phase in which the cords mature and irreversible digital contractures occur, which leads to a significant impairment in the function of the hand [4]. However, disease progression is not inevitable, as only 30-50% develop progressive flexion formalities [5, 6] and the course of DD can fluctuate over time [7].
Active disease. Clinically, these patients showed palmar thickening and associated joint contracture, with the patient`s contracture occurring on average over 3 years. The nodules were mainly made up of myofibroblasts, with very little collagen in between. The nodules were connected by relatively acellular cords. It is not known exactly what causes most cases of Dupuytren`s contracture. Some speculate that hand injuries or repetitive movements with the hands can increase a person`s risk, although there isn`t much evidence that this is true. Essentially, anything that increases inflammation (the root of most diseases) can contribute to damaging or making the fascia in the hands sick. Three studies reported the use of vitamin E [18, 35, 36]. Based on clinical evidence that daily administration of 200 mg of ephyne over 20 weeks resulted in decreased palmar fibrosis and increased numerical dilation in 13 patients (22 hands) affected by DD to varying degrees and who had never had surgery before [55], the hypothesis was assumed [18] that vitamin E downregulates fibroblast activity. Six patients with early DD, defined as Grade 1 (palmar fascia fibrosis without contractures), were treated with 300 mg of mixed natural tocopherols for up to 7 months.
Four patients were reported as „cured“ and 2 as „improved“ [18]. One day, we expect to be able to offer a drug to people with Dupuytren to prevent the progression or recurrence of contractures. So far, however, we are only stuck with treatments for the symptoms of Dupuytren`s disease. For this reason, Dupuytren can eventually return and will almost always do so. In these cases, additional treatment may be considered. Certain risk factors may increase the likelihood that you will develop Dupuytren`s contracture, including: Certain foods may be able to contribute to your symptoms. As a natural part of a healthy diet, you`ll likely avoid large amounts of processed foods and foods high in salt, artificial sweeteners, and additives. New disease-specific patient-reported outcome measures (PROMs). These need to be developed to get the patient`s perspective in the early disease and to monitor the progression of the disease. PROMS have been developed and validated in advanced diseases, but these are unlikely to reflect the problems of patients with nodules with little or no contracture. Terms of Use and Important Information: This information is intended to supplement, not replace, the advice of your doctor or health care provider and not to cover any possible uses, precautions, interactions or side effects. This information may not match your specific health situation.
Never delay or ignore getting professional medical advice from your doctor or other qualified health care provider because you`ve read something on WebMD. You should always talk to your doctor before starting, stopping, or changing any prescribed part of your health plan or treatment and determine which treatment is best for you. Dupuytren`s disease is a common fibrotic disorder of the palm of the hand, characterized by the development of progressive flexion deformities in the fingers that lead to significant functional impairment. Surgical excision remains the most common treatment. However, this is indicated only in patients with established contractures and not in patients with early disease. Early disease is usually characterized by the presence of palmar nodules with limited or no contracture of the fingers. .