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  • Summary
  • Epidemiology
  • Etiology
  • Anatomy
  • Classification
  • Presentation
  • Imaging
  • Differential
  • Diagnosis
  • Treatment
    • Nonoperative
      • observation
        • indications
          • nodules alone
          • no functional impairment
      • hand therapy
        • indications
          • mild cases with minor contracture
      • corticosteroid injections
        • indications
          • painful nodules
        • outcomes
          • up to 50% recurrence rate
          • concerning adverse effects of fat atrophy, pigment changes, and tendon rupture
      • collagenase clostridium histolyticum (CCH) injections
        • Metalloprotease derived from Clostridium Histolyticum 
        • indications
          • treatment of adult patients with a palpable cord
        • outcomes
          • early efficacy seen with injections of clostridial collagenase into Dupuytren's cords
            • causes lysis and rupture of cords
          • able to correct MCP/PIP contracture to <5°
          • more successful at MCP correction than PIP correction
          • PIP recurrence more severe than MCP recurrence
          • disadvantage: cost and only able to address 2 cords per treatment visit
      • percutaneous needle aponeurotomy (PNA)
        • indications
          • mild contractures (at the MCP > PIP)
          • medical co-morbidities that preclude surgery
        • outcomes
          • more successful for MCP contracture than PIP
          • less improvement and higher recurrence rate than surgery (open partial fasciectomy)
          • disadvantages include iatrogenic injury to nerves and tendons and up to 58% recurrence rate
    • Operative
      • partial palmar fasciectomy
        • indications
          • MCP flexion contractures > 30°
          • PIP flexion contractures
          • painful nodules are not an indication for surgery
        • techniques
          • partial fasciectomy: removal of all diseased tissue 
          • open palm fasciectomy (McCash technique)
      • total/radical palmar fasciectomy 
        • indications
          • rarely needed for primary cases
          • severe, diffuse disease
          • multiple joint involvement
          • recurrences
        • technique
          • total/radical fasciectomy: removal/release of all diseased and non-diseased tissue 
      • salvage techniques
        • indications
          • for chronically recurrent and advanced disease
        • technique
          • dermofasciectomy: removal/release of all diseased and non-diseased tissue including the overlying skin  
            • skin grafting may be necessary
          • arthrodesis
          • amputation
        • outcomes
          • skin grafts rarely fail to "take" even if placed directly over neurovascular bundles/flexor sheath
          • Dupuytrens recurrence is uncommon beneath a skin graft 
  • Techniques
  • 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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