Blog
Peyronie’s Disease and Dupuytren’s
Dupuytren’s is one manifestation of a systemic fibrotic disorder that can also show up as Ledderhose, frozen shoulder or Peyronie’s disease. Fortunately, the majority of people affected show only one of these conditions, but many have to deal with several or all of these. This summary reviews the condition referred
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
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
CMMS therapy for stiffness after fasciectomy for Dupuytren’s
Stiffness is a common problem after fasciectomy, particularly loss of flexion, and can be resistant to stretching exercises or splints. This therapy program, incorporating a combination of casting and active exercises, helped patients regain motion when they had failed conventional hand therapy: https://dupuytrens.org/DupPDFs/2007_Rose.pdf
NICE evaluation of needle aponeurotomy for Dupuytren’s
The source of medical information is critical; objectivity is essential. That’s one of the advantages of the UK’s NHS independent review process. Read their assessment of needle aponeurotomy:https://dupuytrens.org/DupPDFs/2004_NICE.pdf
Drugs that provoke Dupuytren’s Disease
Looking for ways to stop Dupuytren’s, it should be useful to look in reverse at factors which may start it, such as protease inhibitor drugs, as reported here: https://dupuytrens.org/DupPDFs/2002_Florence_1607.pdf
Dupuytren’s, Mast cells, Substance P
Dupuytren’s is not always painless. Sometimes, active areas itch and burn. This goes along with the finding of elevated levels of mast cells and nerve fibers containing substance P – something also found in interstitial cystitis. Find out more at https://dupuytrens.org/DupPDFs/2006_Schubert_1071.pdf
Aggressive Dupuytren’s Disease
This report of Dupuytren’s extending from the palm into the forearm reviews the anatomy of involvement and points out the aggressive nature of Dupuytren’s in young people. We need more effective biologic treatments: https://dupuytrens.org/DupPDFs/1997_Sinha_1048.pdf
Dupuytren’ s Contracture – Microscopic Analysis
This is a classic article on the biology of Dupuytren’s. Structural changes in the palmar fascia are associated with type III collagen, which isn’t normally found in this tissue. Myofibroblasts are likely the source of this and are associated with disease recurrence.Most important quote: “Clinical recurrence was not related to
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
