Cleland’s ligaments and Dupuytren’s disease

2013 ◽  
Vol 39 (5) ◽  
pp. 477-481 ◽  
Author(s):  
D. J. Shewring ◽  
U. Rethnam
Keyword(s):  
Histological Analysis ◽  
Residual Disease ◽  
Flexion Contracture ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Histological Findings ◽  
Dupuytren's Disease ◽  
Pip Joint ◽  
Joint Flexion ◽  
Neurovascular Bundles

The aim of this study was to investigate whether Cleland’s ligaments are affected by Dupuytren’s disease and assess their contribution to the flexion contracture of the proximal interphalangeal (PIP) joint. Twenty patients with Dupuytren’s disease undergoing fasciectomy for a PIP joint contracture > 40° (mean 61°, range 45°–100°) were included. After excision of all other identifiable digital disease, Cleland’s ligaments were assessed. If they appeared to be macroscopically affected by Dupuytren’s disease they were excised, sent for histological analysis, and any further improvement of PIP joint contracture was recorded. There were 14 males and six females with a mean age of 62 (range 40–79) years. Excision of Cleland’s ligaments resulted in a mean further correction of 7° (range 0°–15°). Histological analysis indicated that Cleland’s ligament was clearly involved with Dupuytren’s disease in 12 patients, indicating that Cleland’s ligaments can be affected by Dupuytren’s disease. In the remaining specimens the histological findings were equivocal. As these structures are situated dorsal to the neurovascular bundles, a specific dissection has to be undertaken to identify them. Excision of Cleland’s ligaments at digital fasciectomy further avoids leaving residual disease and may yield a worthwhile further correction of PIP joint flexion contracture.

scholarly journals Finger shortening for Dupuytren’s disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 11
Author(s):  
Yoko Ito ◽  
Kiyohito Naito ◽  
Nana Nagura ◽  
Yoichi Sugiyama ◽  
Hiroyuki Obata ◽  
...  
Keyword(s):  
Daily Living ◽  
Treatment Method ◽  
Flexion Contracture ◽  
Dupuytren’S Disease ◽  
High Patient Satisfaction ◽  
Dupuytren's Disease ◽  
Extended Position ◽  
Pip Joint ◽  
Joint Flexion ◽  
Little Finger

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren’s disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren’s disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

The Proximal Interphalangeal Joint in Dupuytren’s Disease

1985 ◽  
Vol 10 (3) ◽  
pp. 358-364
Author(s):  
M. A. TONKIN ◽  
F. D. BURKE ◽  
J. P. W. VARIAN
Keyword(s):  
Surgical Approach ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Average Percentage ◽  
Percentage Improvement

In one hundred patients with Dupuytren’s disease, one hundred and fifty-four operations were performed. The average pre-operative proximal interphalangeal joint contracture was 42° and the average percentage improvement in proximal interphalangeal joint extension at post­operative review was 41%. Fourteen amputations were performed (9.1%). The primary deformity is caused by disease involvement of the palmar fascial structures. Secondary changes may prevent correction of the deformity despite excision of the contracted fascia. The anatomy of the joint is reviewed together with the primary and secondary mechanisms of joint contracture in Dupuytren's disease. Arthrodesis, osteotomy of the proximal phalanx and joint replacement are considered as alternatives to amputation when a systematic surgical approach fails to correct the flexion contracture.

scholarly journals The influence of Dupuytren's disease fingers contracture degree on surgical treatment outcome

2017 ◽  
Vol 74 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Nenad Stepic ◽  
Jovana Koncar ◽  
Milica Rajovic
Keyword(s):  
Surgical Treatment ◽  
Functional Limitations ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Optimal Time ◽  
Dupuytren's Disease ◽  
Significant Difference ◽  
Pip Joint ◽  
Group 3 ◽  
Reduction Index

Background/Aim. Dupuytren?s disease is a progressive disease of the palmar and digital fascial structures, with functional limitations. There are no clear recommendations about the optimal time of surgical repair, concerning the hand impairment. The aim of our study was to investigate the relation between finger?s contracture degree and success of surgical treatment of the Dupuytren's disease. Methods. This prospective analysis included 60 patients operated on due to Dupuytren?s contracture. According to preoperative contracture degree of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint, patients were divided into three groups: the group 1: < 15?, the group 2: 15?30? and the group 3: > 30?. All the patients underwent operation of partial palmar fasciectomy. Postoperative improvement was expressed with contracture reduction INDEX. Results. There were 60 patients with 85 fingers affected. The groups 1, 2 and 3 had 22 (37%), 37 (62%) and 26 (43%) fingers with MCP contracture and 32 (37.4%), 24 (28.2%) and 29 (34.1%) fingers with PIP contracture, respectively. Postoperative contractures of MCP joint in these groups were 0, 0.135? and 5?, and of PIP joint 0, 2.08 ? and 16.89?, respectively. After six months all MCP contractures resolved, while PIP joint contracture in the group 3 remained 13.62?. The reduction INDEX was 98.85%, 97.62% and 75.52% in the groups 1, 2 and 3, respectively. There was a statistically significant difference in the INDEX value between the groups (p = 0.0001). Conclusion. The degree of PIP joint contracture is related to the outcome of surgical treatment of Dupuytren?s disease. Optimal results are achieved when contracture degree is between 15? and 30?. Surgical treatment of MCP joint contracture is successful regardless of the preoperative joint contracture degree.

THE McCASH TECHNIQUE FOR DUPUYTREN'S DISEASE: OUR EXPERIENCE

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 61-67 ◽  
Author(s):  
Aristides B. Zoubos ◽  
Nikolaos A. Stavropoulos ◽  
George C. Babis ◽  
Andreas F. Mavrogenis ◽  
Zinon T. Kokkalis ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Sensory Evaluation ◽  
Rehabilitation Program ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Bilateral Involvement ◽  
Pip Joint ◽  
The Mean ◽  
Acceptable Outcome

This study presents the clinical outcomes of 35 hands with Dupuytren's Disease treated with the McCash technique between 1990 and 2009. Of the 31 patients (28 males and three females, mean age 53 yrs), four patients had bilateral involvement (12.9%). Thirty hands had no previous medical or surgical treatment for the disease, while the remaining five hands had been operated on at least once. The mean contracture of metacarpophalangeal (MCP) joint improved from 42.14° to 1.83°, while that of the proximal interphalangeal (PIP) joint improved from 62.60° to 7.09°. All wounds healed within a mean 9.8 weeks. Sensory evaluation revealed no permanent numbness. With realistic expectations, clear documentation, meticulous surgical technique and implementation of a demanding post-operative rehabilitation program, an acceptable outcome may be achieved with the McCash technique for Dupuytren's disease.

The Use of Skeletal Traction to Correct the Flexed PIP Joint in Dupuytren’s Disease

1994 ◽  
Vol 19 (4) ◽  
pp. 534-537 ◽  
Author(s):  
P. D. HODGKINSON
Keyword(s):  
Recurrent Disease ◽  
Flexion Angle ◽  
Simple Device ◽  
Dupuytren’S Disease ◽  
Skeletal Traction ◽  
Dupuytren's Disease ◽  
Pip Joint

The flexed PIP joint presents a particular problem in the treatment of advanced Dupuytren’s disease. Following reports of the use of skeletal traction in the treatment of this condition, a simple device, the “Pipster” was developed to extend the PIP joint by skeletal traction before surgery. In seven fingers in five patients with severe contractures, there was a pre-operative improvement of at least 45° in the flexion angle (measured as maximum achievable passive extension). The technique was effective in primary and recurrent disease. Subsequent surgery was facilitated and amputation avoided in five tigers. The optimum distraction technique was identified. The study continues with more patients.

Anterior Tenoarthrolysis for Severe Flexion Contracture of the Fingers (The “Tata” Operation): A Review of 50 Cases

2007 ◽  
Vol 32 (2) ◽  
pp. 224-229 ◽  
Author(s):  
P. LOREA ◽  
J. MEDINA HENRIQUEZ ◽  
R. NAVARRO ◽  
P. LEGAILLARD ◽  
G. FOUCHER
Keyword(s):  
Flexion Contracture ◽  
Salvage Procedure ◽  
Extension Deficit ◽  
Salvage Operation ◽  
Active Range Of Motion ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Joint Flexion ◽  
The Mean

The “hook finger”, with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus. The mean PIP and DIP extension deficit pre-operatively was 133° with a mean PIP lag of extension of 83°. With a mean follow-up of 7.8 years, 45 fingers were improved, five were not and none was worsened. The mean PIP and DIP extension deficit postoperatively was 47°, with a mean PIP lack of extension of 31°. The overall gain in extension deficit of both joints was 86° and of the PIP was 52°. One PIP joint developed septic arthritis immediately after surgery. The benefit of this salvage operation is mainly in the change of the active range of motion to a more functional arc.

scholarly journals Dupuytren’s disease digital radius IV right hand and carpal tunnel syndrome on ipsilateral hand

2015 ◽  
Vol 21 (4) ◽  
pp. 178-185 ◽  
Author(s):  
Sebe Ioana Teona ◽  
I. Lascar ◽  
M. Valcu ◽  
B. Caraban ◽  
Colcigeanu Anca
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Healing Process ◽  
Flexion Contracture ◽  
Dupuytren’S Disease ◽  
Motor Deficit ◽  
Dupuytren's Disease ◽  
Right Hand ◽  
Tunnel Syndrome

Abstract Dupuytren’s contracture is a fibroproliferative disease whose etiology and pathophysiology are unclear and controversial. It is a connective tissue disorder, which takes part in the palmar’s fibromatosis category and has common characteristics with the healing process. Dupuytren’s disease is characterized by the flexion contracture of the hand due to palmar and digital aponevrosis. It generally affects the 4th digital radius, followed by the 5th one. Without surgery, it leads to functional impotence of those digital rays and/or hand. It is associated with other diseases and situational conditions like Peyronie’s disease, the Lederhose disease (plantar fibromatosis), Garrod’s digital knuckle-pads, diabetes, epilepsy, alcoholism, micro traumatisms, stenosing tenosynovitis and not the least with carpal tunnel syndrome. The carpal tunnel syndrome is a peripheral neuropathy with the incarceration of the median nerve at the ARC level, expressed clinically by sensory and motor disturbances in the distribution territory of the median nerve, which cause functional limitations of daily activities of the patient. After the failure of the nonsurgical treatment or the appearance of the motor deficit, is established the open or endoscopic surgical treatment with the release of the median nerve. Postoperative recovery in both diseases is crucial to the functionality of the affected upper limb and to the quality of the patient’s life. The patient, a 61 years old man, admitted to the clinic for the functional impotence of the right hand, for the permanent flexion contracture of the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) of the 4th finger with extension deficit, for the damage of the thumb pulp clamp of the 4th finger, for nocturnal paresthesia of fingers I-III and pain that radiates into the fingertips. After clinical, paraclinical, imagistic and electrical investigations, surgery is practiced partial aponevrectomy, carpal ligament section, external neurolysis of the median nerve, flexor tendon tenolisys. The particularity of this case is the coexistence of two pathologies: Dupuytren’s disease and carpal tunnel syndrome, the decision to solve in the same operator time and the problem of immobilization. Reportation of this case supports previous reports in literature, such as Dupuytren’s disease and carpal tunnel syndrome are observed at the same patient, at the same time or one after another.

Dupuytren’s Disease Following Acute Injury in Japanese Patients: Dupuytren’s Disease or Not?

2007 ◽  
Vol 32 (5) ◽  
pp. 569-572 ◽  
Author(s):  
Y. ABE ◽  
T. ROKKAKU ◽  
T. EBATA ◽  
S. TOKUNAGA ◽  
T. YAMADA
Keyword(s):  
Diabetes Mellitus ◽  
Elective Surgery ◽  
Middle Finger ◽  
Japanese Patients ◽  
Flexion Contracture ◽  
Dupuytren’S Disease ◽  
Acute Injury ◽  
Separate Entity ◽  
Dupuytren's Disease ◽  
Age And Sex

This paper reports the development of Dupuytren’s disease following acute injury in 16 hands in 14 Japanese patients. The patients included six women and eight men. Five patients developed disease following trauma, one following infection and eight following elective surgery. In the present series, the patient age and sex are irrelevant. The disease was unilateral, confined to a single digital ray, and without ectopic lesions in most cases. Disease presented predominantly in the ring or middle finger rays. There were only three patients who underwent surgery for definite flexion contracture. Diabetes mellitus was the most frequently associated risk factor. Our results suggest that Dupuytren’s disease following acute injury could be considered a separate entity from typical Dupuytren’s disease. At present, we believe that this condition should be considered a subtype of Dupuytren’s disease.

A Comparison of Methods of Treatment of Pip Joint Contractures in Dupuytren’s Disease

1996 ◽  
Vol 21 (2) ◽  
pp. 246-251 ◽  
Author(s):  
C. M. BREED ◽  
P. J. SMITH
Keyword(s):  
Surgical Intervention ◽  
Dupuytren’S Disease ◽  
Comparison Of Methods ◽  
Flexion Deformity ◽  
Dupuytren's Disease ◽  
Joint Contractures ◽  
Joint Level ◽  
Pip Joint ◽  
Methods Of Treatment

An analysis of the different methods of treating residual flexion deformity at the PIP joint level after digital fasciectomy in 75 PIP joints has shown that gentle passive manipulation alone gives better results with fewer complications than more aggressive surgical intervention.

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