scholarly journals Needle aponeurotomy for dupuytren’s contracture.

2019 ◽  
Vol 26 (08) ◽  
pp. 1300-1305
Author(s):  
Muhammad Arif ◽  
Saeed Ahmed Shaikh ◽  
Badaruddin Sahito ◽  
Nadeem Ahmed ◽  
Muhamamd Qasim ◽  
...  
Keyword(s):  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Prospective Longitudinal Study ◽  
Dupuytren's Contracture ◽  
Number Of Patients ◽  
Acute Correction ◽  
Stage 1 ◽  
Prospective Longitudinal ◽  
Needle Aponeurotomy

Needle Aponeurotomy is a negligibly obtrusive method where the cords are debilitated through the manipulation & insertion of a small needle. To determine the frequency of recurrence of flexion contracture after correction by percutaneous needle Aponeurotomy. Study Design: Prospective longitudinal study. Setting: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi. Period: March 2017 to February 2018. Materials and Methods: 65 patients were collected for this study with dupuytren’s contracture from stage I-III belonging to either sex of age 18-50 years presented in outpatient department. Results: Total 65 patients were included in the study. Mean flexion contracture was 35.840 with the standard deviation of 13.070. Most of the patients 44(67.7%) had flexion contracture of >300 while 21(32.3%) patients had flexion contracture of ≤300. Majority of the patients had stage 1 of Dupuytren’s contracture, i.e. 26(40%), 25(38.5%) patients were of stage 2 contracture. Least number of patients i.e. 14 (21.5%) had stage 3 Dupuytren’s contracture. Recurrence of contracture was observed in 46(70.8%) of patients, while 19(29.2%) patients had no recurrence of contracture. Conclusion: The frequency of recurrence of flexion contracture found significant after correction with percutaneous needle aponeurotomy, so should be carried in selective patients with counseling’s that it will recur. But acute correction can be made at metacarpophalangeal and proximal interphalangeal joint with needle aponeurectomy.  

The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures

2015 ◽  
Vol 41 (6) ◽  
pp. 609-613 ◽  
Author(s):  
P. E. Blazar ◽  
E. W. Floyd ◽  
B. E. Earp
Keyword(s):  
Case Series ◽  
Tendon Sheath ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Joint Contractures ◽  
Dupuytren's Contracture

Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren’s fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren’s contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30–90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0–40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren’s contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren’s contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients. Level of Evidence: IV (Case Series, Therapeutic)

Validation of a Handprint for Clinical Evaluation of Dupuytren’s Contracture

2021 ◽  
Author(s):  
Takashi Ajiki ◽  
Akira Murayama ◽  
Yukinori Hayashi ◽  
Katsushi Takeshita
Keyword(s):  
Clinical Evaluation ◽  
High Reliability ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Therapeutic Effects ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Palmar Surface ◽  
Patient Reported ◽  
Quick Dash

Abstract Objective We have developed a handprint-based method for visualizing and quantifying the palmar contact of patients with Dupuytren’s contracture. The purpose of this study was to examine whether the generated handprint was useful for assessing the severity of flexion contracture of the fingers and for evaluating the therapeutic effects of collagenase clostridium histolyticum (CCH) injection for Dupuytren’s contracture. Methods The handprint was created by applying medical-grade ethanol-containing hand sanitizer over the entire palmar surface of the affected hand and then pressing it on thermal paper for word processors. The reliability of the handprint was evaluated through test–retest of 10 healthy volunteers at an interval of 10 days, and the validity of the handprint was assessed using a flexion contracture model in which the little finger was fixed in an Alfence splint. In addition, we obtained handprints of the affected hand in 33 patients with unilateral Dupuytren’s contracture both before CCH injection and at the final observation after injection to investigate the contact area of the hand (CAH) and the length of the hand (LH). The relationships between CAH, LH, total extension deficit angle (TEDA), and patient-reported outcome measures (Japanese Society for Surgery of the Hand Version of the Quick Disability of Arm, Shoulder, and Hand Questionnaire [Quick DASH-JSSH] and Hand20) were examined. Results The test–retest correlation coefficient was 0.9187 (p < 0.001) for CAH and 0.9052 (p < 0.001) for LH, indicating high reliability of the handprint. The ratios of CAH and LH decreased gradually as the contracture angle of the splinted finger increased. The handprint revealed a marked improvement of palmar contact after CCH injection for Dupuytren’s contracture. Furthermore, the ratios of CAH and LH were strongly correlated with TEDA, Quick DASH-JSSH, and Hand20 before treatment. Conclusion Our handprint-based assessment method was extremely useful for clinical evaluation of CCH treatment for Dupuytren’s contracture. Type of Study/Level of Evidence Therapeutic.

Novel patient-specific visual analogue survey (PVS) is validated in patients treated with collagenase injection for Dupuytren’s disease

2019 ◽  
Vol 5 (1) ◽  
pp. 3-9
Author(s):  
Stephen L Lyman ◽  
Jayme Burket Kotsov ◽  
Chisa Hidaka ◽  
Quynh Tran ◽  
Naomi Roselaar ◽  
...  
Keyword(s):  
Effect Size ◽  
External Validation ◽  
Patient Specific ◽  
Dupuytren’S Contracture ◽  
Post Injection ◽  
Retest Reliability ◽  
Dupuytren's Contracture ◽  
Number Of Patients ◽  
Patient Reported ◽  
Test Retest Reliability

ObjectivesWe developed and validated an electronically administered patient-specific visual analogue survey (PVS) to evaluate changes in hand function after treatment with injectable collagenase clostridium histolyticum (CCH) in Dupuytren’s contracture. The items in the PVS were authored and ranked in importance by the patients.MethodsIn an open-label trial for patients with Dupuytren’s contracture receiving CCH injection, 109 patients completed the PVS on the day of injection, day of manipulation and 30-day follow-up. For external validation, patients also completed standard patient-reported outcome measures, the Overall Treatment Effects Scale and QuickDASH, and underwent physician assessment of contracture via goniometry and the table top test.ResultsResponses were highly individualised with no single activity being chosen as important by more than 8% of patients. Sports-related activities were mentioned most often (23%). The PVS was highly responsive to changes in patients’ conditions with CCH injection (effect size=1.49), much more so than the QuickDASH (effect size=0.50). Additionally, the PVS had no floor or ceiling effects, whereas the QuickDASH ceiling approached 20% post-injection. The PVS had excellent internal consistency (Cronbach’s α=0.95) and correlated strongly with the QuickDASH post-injection (Spearman’s=−0.67). PVS scores were significantly higher for patients reporting their condition had improved versus those reporting no change after injection. The test–retest reliability of the PVS was poor to fair, in part due to allowing patients to choose different activities at test and retest. However, test–retest reliability was good (intraclass correlation coefficient >0.7) and better than QuickDASH among patients who rated the same activities at test and retest.ConclusionsThe PVS is simple to administer and enables individualised assessment in a large number of patients. It is also readily adaptable for use in other diseases, particularly within musculoskeletal medicine.Level of evidenceTherapeutic II: Prospective cohort.

Comparative Effectiveness of Percutaneous Needle Aponeurotomy and Limited Fasciectomy for Dupuytren’s Contracture

2016 ◽  
Vol 138 (4) ◽  
pp. 837-846 ◽  
Author(s):  
Chao Zhou ◽  
Ruud W. Selles ◽  
Harm P. Slijper ◽  
Reinier Feitz ◽  
Yara van Kooij ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture ◽  
Limited Fasciectomy ◽  
Needle Aponeurotomy

scholarly journals Advantages and Disadvantages of Various methods for Dupuytren’s Contracture

2017 ◽  
Vol 24 (2) ◽  
pp. 61-68
Author(s):  
A. A Ulishchenko ◽  
I. O Golubev
Keyword(s):  
Dupuytren’S Contracture ◽  
Advantages And Disadvantages ◽  
Dupuytren's Contracture ◽  
Choice Of Treatment ◽  
Invasive Techniques ◽  
Needle Aponeurotomy

Current methods for Dupuytren’s contracture treatment - conservative, radical surgical, low invasive are presented. Their advantages and disadvantages are discussed. Unfortunately no one method allows to avoid relapses at various terms after treatment. In the lack of common approach to the choice of treatment tactics the low invasive techniques such as needle aponeurotomy, collagenase injections, percutaneousaponeurotomywith lipofilling (lipografting)are becoming more popular.

scholarly journals Dynamic Manugraphy as a Promising Tool to Assess the Outcome of Limited Aponeurectomy in Patients With Dupuytren's Contracture

2021 ◽  
Vol 7 ◽  
Author(s):  
Angelina Garkisch ◽  
Thomas Mittlmeier ◽  
Axel Kalpen ◽  
Marion Mühldorfer-Fodor ◽  
Dagmar-C. Fischer ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Grip Force ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Base Line ◽  
Dash Score ◽  
Force Transmission ◽  
Additional Tool ◽  
Dupuytren's Contracture

Background: Dupuytren's contractures interfere with physiological gripping. While limited aponeurectomy is an accepted treatment modality to restore finger mobility, methods to objectify functional outcome beyond determination of the range of motion are scarce.Methods: Patients with Dupuytren's contracture being scheduled for unilateral limited aponeurectomy were invited to participate. Clinical data were gathered prospectively by chart review and interview. The DASH-score and flexion contracture for fingers were registered prior to surgery, 3 and 6 months afterwards. At the same time, dynamic manugraphy for simultaneous recording of the grip pattern and forces generated by the affected hand and anatomic areas (i.e., thumb, index finger, middle finger, ring finger, little finger and palm) were performed. All findings obtained during the follow-up period were compared to the situation at baseline. Comparison between paired samples was done using Wilcoxon rank test. All p-values are two-sided and p &lt; 0.05 was considered to be significant.Results: Out of 23 consecutively enrolled patients, 19 (15 men, 4 women) completed follow-up examinations. Manugraphy confirmed the impairment of physiological gripping with concomitant pathological load distribution at base line. Limited aponeurectomy significantly reduced flexion contractures. However, the DASH-score remained at an excellent level in one patient, indicated improvement in 11 and worsening in seven patients. Six patients had lower grip force at t6 compared to the preoperative condition, although the preoperative flexion contracture (≥110°) was considerably improved in all of them. In four of those, the DASH-score improved while it turned worse in two of them. The force of surgically treated fingers remained unchanged in three patients while it was improved and worsened in half of the remaining patients, respectively. Manugraphy revealed physiological gripping by enlargement of contact area and higher force transmission by the fingertips in 10 of 12 patients with constant or even improved DASH-score and in three of seven patients with a worsened DASH-score.Conclusions: Assessing the reduction of flexion contracture and grip force alone is not sufficient to comprehensively reflect the functional outcome of aponeurectomy for Dupuytren's disease. Visualizing physiological grip pattern provides an additional tool to objectify the success of surgical treatment.

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