A Sampling of Patient Information Brochures on Dupuytren’s
What do health care providers think you should know or want to know about Dupuytren’s? Here is a sampling of patient information materials from the government http://dupuytrens.org/DupPDFs/2010_NHS-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_OBS-ptinfo.pdf, organizations of hand surgeons http://dupuytrens.org/DupPDFs/2010_AAHS-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_ASSH-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_BSSH-ptinfo.pdf, individual physicians and hospitals http://dupuytrens.org/DupPDFs/2010_eHand-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_KWO-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2002_Hurst-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_Lancashire-ptinfo.pdf and hand therapists http://dupuytrens.org/DupPDFs/2010_Kramer-ptinfo.pdf. Of course, a wide range of information is […]
Needle Aponeurotomy for Dupuytren’s
Needle aponeurotomy for Dupuytren’s contracture is a type of fasciotomy performed under local anesthesia. Compared to fasciectomy, it is less of an ordeal for the patient in terms of both procedure and recovery and has a lower complication rate. This report (full text: http://www.dupuytrenfoundation.org/DupPDFs/2008_Cheng_1610.pdf) reviews one group’s experience with needle aponeurotomy.
Dupuytren’s and Transforming Factor Beta Genetics
What is the initial abnormality which ultimately results in Dupuytren’s? Because biologic systems are guided by tiny triggers which start a cascading series of events, tiny differences can have large effects, and the hunt is sometimes for tiny differences early in the game. Transforming Factor Beta One (TGF-ß1) is one of the starting players in […]
Dermofasciectomy reconsidered
There are three mechanical approaches for Dupuytren’s. In order of both increasing problems and long term effectiveness, these are: fasciotomy (cut fascia); fasciectomy (remove fascia); dermofasciectomy (remove both skin and fascia). The popularity of dermofasciectomy and skin grafting has been limited by concerns regarding complications of wound healing and loss of flexion. Some of these […]
Matrix Metalloproteinases and Dupuytren’s
What are matrix metalloproteinases and how are they linked to Dupuytren’s? Matrix Metalloproteinases (MMPs) are naturally occuring enzymes whose name describes them: they are found outside cells in the extracellular matrix, their molecular makeup includes a metal (Zinc) and they break down proteins. Human collagenase, which breaks down collagen, is in this group, and Dupuytren’s […]
Cortisone shots for Dupuytren’s nodules
Cortisone injections have been used for many years as an early treatment for Dupuytren’s in the nodular stage of involvement. This approach is based on clinical experience, but what is the actual biology? It may have to do with the finding that tissue matrix as well as the blood vessel cells in Dupuytren’s nodules have […]
Feedback Loops in Dupuytren’s
The best hope for finding a medical cure for Dupuytren’s and other fibrotic conditions is through a better understanding of abnormal cell signalling feedback loops regulating fibrosis. Cellular collagen metabolism regulation is not fully understood. Here are a few puzzle pieces. The protein transforming growth factor beta (TGF-ß), among other things, signals myofibroblasts to produce […]
The Dupuytren Symposium is coming!
As tomorrow’s deadline for abstract submission nears, internet connections are heating up at command central for the 2010 International Symposium on Dupuytren’s Disease. The symposium syllabus looks very exciting, with some amazing new reports. Session topics have solidified as: The Myofibroblast; Genetics and Demographics; Disease Concepts; Collagen and Collagenase; Surgical Treatments; Energy Based Treatments; Manual […]
Needle Release of Dupuytren’s: 2010 Manual of Technique
Percutaneous fasciotomy for Dupuytren’s contracture is an old procedure, but was reinvented by Dr. Lermusiaux in Paris in the 1980s, who used a small needle rather than a scalpel. This modification allows the procedure to be performed using almost no anesthesia, which gives an unprecedented safety margin: the patient can easily confirm whether nerves or […]
Management strategies for Dupuytren’s
The management options for people with Dupuytren’s can appear as confusing as the biology. This review provides a nice overview of Dupuytren’s disease and a practical decision tree approach to manage hands affected by Dupuytren’s. It’s worth a read: http://www.dupuytrenfoundation.org/DupPDFs/2006_Bayat_1586.pdf
