Oxygen Free Radicals and Dupuytren’s
Oxygen free radicals affect Dupuytren’s fibroblasts: high levels are toxic, but not only do slightly elevated levels stimulate fibroblast activity, active fibroblasts actually produce oxygen free radicals. Which is the chicken and and which is the egg? This seminal paper reports studies of the effects of oxygen free radicals on Dupuytren and normal fibroblasts, the […]
Viking blood, blue eyes and other risk factors for Dupuytren’s
What is the actual story of the Vikings and Dupuytren’s? The full history will never be known, but some fascinating details on this and other risk factors, including blue eyes, are reviewed here: https://www.dupuytrens.org/DupPDFs/2001_Flatt_1397.pdf. See page 4 for a decision tree showing how to predict the risk of recurrence after surgery based on family history, […]
Sorting out the truth
Don’t believe everything you read about Dupuytren’s – even in respectable journals. I was aware that reflex sympathetic dystrophy (complex regional pain syndrome) was more common after fasciectomy for Dupuytren’s than for other hand operations, but there is little published on this. Then, this report came out documenting surprisingly high incidence of this complication, higher […]
Lessons from Peyronie’s for Dupuytren’s
Peyronie’s disease is more common than Dupuytren’s – 3 to 9 percent of the population – and shares a similar biology and genetic predisposition. Progress in the treatment of Peyronie’s will benefit that of Dupuytren’s and vice versa. Taken in this context, these two articles by Hellstrom from 2000 and 2009 are very thought provoking. […]
Stretching may provoke Dupuytren’s
The relationships between mechanical forces and the biochemistry of Dupuytren’s are only recently being sorted out. Clinically, Dupuytren’s activity responds to changes in mechanical stresses: active nodules soften in response to reducing tension by adjacent fasciotomy; disease activity after fasciectomy may be provoked by overly aggressive stretching and splinting. Biochemically, this may relate to the […]
The Open Palm Technique for Dupuytren’s
The Open Palm Technique for Dupuytren’s contracture has advantages – lack of hematoma, lower incidence of sympathetic dystrophy. The classic McCash version of this procedure combines closure of zigzag finger incisions, leaving transverse palm wounds open. The Burkhalter version, developed by Dr. Mann, employs only transverse incisions in the palm and fingers, all of which […]
Dupuytren’s and Frozen shoulder
About one in six patients with frozen shoulder will also have Dupuytren’s disease and vice versa. Frozen shoulder has been called “Dupuytren’s of the shoulder”: the abnormal tissues are quite similar. However, they are different in other respects – for example, Dupuytren’s commonly recurs after surgical treatment, but frozen shoulder does not. This study demonstrates […]
Vascular cause of Dupuytren’s?
Diabetes, hypertension, stiff finger joints and Dupuytren’s: This study uses retinopathy as an index of vascular disease and suggests that small vessel disease, rather than the effect of blood sugar on collagen, is the link between diabetes and Dupuytren’s: https://dupuytrens.org/DupPDFs/1986_Larkin_1218.pdf
A landmark advance in understanding Dupuytren’s
Two methods of investigating Dupuytren’s have been used: Demographic – family studies, associations with medications, activities, other diseases; and Biological – tissue analysis. The big biologic breakthrough came in 1972 when Gabbiani and others published two articles back to back findings on the biology of myofibroblasts: https://dupuytrens.org/DupPDFs/1971_Gabbiani.pdf and the role of myofibroblasts in Dupuytren’s Disease: […]
Smooth Muscle Actin in Dupuytren’s Contracture
The palmar fascia in Duputren’s contracture does not contract like a muscle: it’s more like the effect of an army of tiny rachets. Adjacent parallel strands of collagen are grabbed by myofibroblasts, which then shorten (“crimp”) lengthwise, pulling the strands to overlap more and more, and then gluing these strands together with crosslinks. Crimp, lock, […]
