Blog
ß-catenin, Wnt and Dupuytren’s
Ultimately, Dupuytren’s has to do with cell signalling: normal cells are somehow instructed (“signalled”) to become abnormal, and adjacent cells interact with each other in a progression of abnormal changes. One of the many ways that cell signal each other is the Wnt signaling pathway, which involves a series of
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,
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
Chondroitin Sulfate, Dermatan Sulfate and Dupuytren’s
Dermatan sulfate is similar to the nutritional supplement chondroitin sulfate, and used to be called chondroitin sulfate. Dermatan sulfate is unusually abundant in fascia affected by Dupuytren’s. Is it the cause or is it the effect of the abnormal biology of Dupuytren’s? Maybe both, as discussed in this review: https://dupuytrens.org/DupPDFs/2007_Kozma.pdf
Open fasciotomy for Dupuytren’s
Patients with Dupuytren’s need two things, mechanical and biological. The former, a simple and safe way to straighten bent fingers, and the latter, a way to prevent disease progression and recurrence. This article reviews pros and cons of a simple mechanical treatment, open fasciotomy, for severe contractures in a group
Genetic determined biochemistry and Dupuyren’s
The genetic basis of Dupuytren’s is explained by the genetic basis of individual biochemistry and enzymatic variation. Sort of. This fascinating review shows how complicated this can be: https://dupuytrens.org/DupPDFs/2008_Zyluk.pdf
Verapamil, tamoxifen, carnitine – options?
One resource for potential medical treatment of Dupuytren’s is the literature on medicines which work for related conditions such as Peyronie’s. This review examines the rationale and results of propionyl-L-carnitine, acetyl-L-carnitine, verapamil and tamoxifen in treating Peyronie’s disease. Is there a role for these in Dupuytren’s? https://dupuytrens.org/DupPDFs/2002_Cavallini.pdf
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
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
Recent Dupuytren Publications
- Challenges and innovations in the surgical treatment of advanced Dupuytren disease by percutaneous needle fasciotomy: indications, limitations, and medico-legal implications
- Adjuvant Treatment with Celecoxib after Collagenase Injection for Dupuytren Contracture: A Double-Blind Randomised Controlled Trial
- Biochemical and Histological Differences between Longitudinal and Vertical Fibres of Dupuytren's Palmar Aponeurosis and Innovative Clinical Implications
- Alterations in the Structure, Composition, and Organization of Galactosaminoglycan-Containing Proteoglycans and Collagen Correspond to the Progressive Stages of Dupuytren's Disease
- CASTing the net wider: A case report of PLACK syndrome associated with dilated cardiomyopathy