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  • Summary
  • Epidemiology
  • Etiology
  • Anatomy
  • Classification
  • Presentation
  • Imaging
  • Differential
  • Diagnosis
  • Treatment
  • Techniques
    • Hand therapy
      • Ultrasound and heat may be helpful in early stages of disease
      • Bracing/splinting to stretch digits 
        • may delay the progression and potentially improve the degree of flexion contractures of the PIPJ.
    • Collagenase Injections
      • mechanism of action
        • selectively target collagen types I and III
      • technique
        • reconstitution of collagenase lyophilized powder with supplied diluent
        • inject 0.58 mg of collagenase into each palpable Dupuytren’s cord with a contracture of a metacarpophalangeal (MP) joint or a proximal interphalangeal (PIP) joint 
          • up to two joints or two cords in the same hand may be treated during a treatment visit 
        • followed by manipulation within 24-72h under local anesthesia
          • literature has shown that contracture correction is equivalent up to 7 days following collagenase injection
        • injections and finger extension procedures may be administered up to 3 times per cord at approximately 4-week intervals.
      • complications
        • minor
          • edema/contusion, skin tear, pain are most common
        • major (1%) 
          • flexor tendon rupture, CRPS, pulley rupture
        • has low activity against type IV collagen (in basement membrane of blood vessels and nerves) explaining the low neurovascular complication rate
    • Percutaneous needle aponeurotomy (PNA)
      • technique
        • perform in office using 22G or 25G needle
        • followed by manipulation and night orthosis wear
    • Partial palmar fasciectomy
      • technique
        • removal of all diseased tissue only in involved digits
        • dissect from proximal to distal
        • incision options - Brunner zigzag, multiple V-Y, sequential Z-plasties
      • pros
        • most widely used surgical treatment
        • overlying skin is preserved
      • postoperative care
        • early active range of motion (starting postoperative day 5-7)
        • night-time extension brace or splint
    • Open palm technique (McCash technique)
      • approach
        • leave a transverse skin incision open at the distal palmar crease
      • pros
        • reduced hematoma formation
        • reduced risk for stiffness
      • outcome
        • longer healing
        • greater recurrence than if the palmar defect were covered with transposition flap or FTSG
      • rehabilitation and Postoperative Care
        • hand therapy for several 1-3 months, starting 3-5 days postoperatively
          • Paraffin wax treatment
          • Scar and edema management
          • Dynamic and static splinting
          • Phonophoresis and iontophoresis
    • Total/radical palmar fasciectomy
      • infrequently used
      • technique
        • release/excision of all palmar and digital fascia including non-diseased fascia
      • cons
        • high complication rate
        • little effect on recurrence rate (also high)
  • Complications



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Hand⎪Dupuytren's Disease
  • Hand
  • - Dupuytren's Disease
25:15 min
10/15/2019
2133 plays
5.0
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