Dupuytren’s contracture

Dupuytren s contracture is a contraction of the palmar fascia that usually affects the fourth and fifth digits.27 It is not specific to cirrhosis and can be seen in repetitive use injuries. 

This is thickening of the tissue under the skin on the palms and fingers which causes the fingers to curl. It is common in patients with cirrhosis but can also occur in diabetics and epileptics. The cause is not known, although there is a genetic component, and in some cases it may be related to alcoholism. The presence of Dupuytren s contracture is not related to the degree of liver dysfunction. 

The term Dupuytren s contracture (F. Platter, 1614 G. Dupuytren, 1832) denotes a hardening of the palmar fas-... 

Whereas Dupuytren s contracture is only found in about 2% of the population, it is detectable in about 30% of all cirrhosis patients, mainly bilaterally. Men are affected in 90% of cases and thus far more often than women. The disease generally commences unilaterally. Men are frequently affected in their younger years, whereas in women, the disease commences later and takes a more rapid course. There is a greater tendency towards recurrence of the disease after surgery than after radiological treatment. In cirrhosis patients, contracture occurs predominantly in combination with palmar erythema. There also seems to be a correlation between contracture and spider naevi. (2, 4, 12, 23)... 

Attali, R, Ink, O., Pelletier, G., Vernier, C, Jean, F., Moniton, L., Etienne, J.-E Dupuytren s contracture, alcohol consumption, and chronic liver disease. Arch. Intern. Med. 1987 147 1065-1067... 

Barbiturates can cause various connective tissue disorders, including Dupuytren s contracture and frozen shoulder. 

Frozen shoulder has been attributed to indinavir (SEDA-24, 347) (37). In one case it was associated with Dupuytren s contracture and in one case each with arthralgias and tendinitis (38). An adhesive capsulitis seems to be present. 

The incidence of barbiturate-induced Dupuytren s contracture, frozen shoulder, Ledderhose syndrome, Peyronie s disease, fibromas, and joint pains may be up to 10% (6). Most affected patients develop connective tissue changes in the first year, although these become disabling at a later stage. These complications should be recognized early, since they are often reversible (SED-12, 137) (7). 

The evidence has been examined carefully, and it is considered that no case can at present be made for the use of tocopherol in the following conditions in spite of the repeated claims on uncontrolled trials menopausal syndrome, senile vaginitis and pruritus, male infertility, muscular dystrophy, Dupuytren s contracture, fibrositis, Peyronie s disease, interstitial keratitis, angina pectoris, granuloma annulare, lupus erythematosus. 

Badalamente, M.A., Elurst, L.C. 2007. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren s contracture. J Hand SurgAm 32(6), 767-774. 

Makela, E.A., Jaroma, H., Haiju, A., Anttila, S., Vainio, J. 1991. Dupuytren s contracture the long-term results after day surgery. JHand SurgBr 16(3), 272-274. 

Rodrigo, J.J., Niebauer, J.J., Brown, R.L., Doyle, J.R. 1976. Treatment of Dupuytren s contracture. Long-term results after fasciotomy and fascial excision. 

Figure 21. Brdi ka filtrate reaction, course of denaturation in time at 20°C at 7-min intervals. Wave of medium height first increased and then decreased by denaturation Dupuytren s contracture.

Peyronie s disease may be associated with other flbrotic disorders such as Dupuytren s contracture or Lederhosen syndrome. Its association with vascular comorbidities is controversial (Kadioglu et al. 2002 Mulhall et al. 2004 Usta et al. 2004), as is the role of overt trauma such as penile fracture (Zargooshi 2004). 

The frequent occurrence of Dupuytren s contracture with hypercholesterolemia is striking. We have found this lesion in 24 out of 82 cases with EFH. Conversely, elevation of plasma cholesterol is frequent in patients with Dupuytren s contracture in the absence of a family history of EFH. A genetic linkage between these two diseases has been considered (Lohr and Neuffer 1959). 

Manthey DE,StorrowAB,Milbourn JM et al (1996) Ultrasound versus radiography in the detection of soft-tissue foreign bodies. Ann Emerg Med 28 7-9 Markham DE, Wood MR (1980) Ultrasound for Dupuytren s contracture. Physiotherapy 66 55-58 Martinoli C, Bianchi S, Derchi LE et al (2000) Sonographic evaluation of digital annular pulleys tears. Skeletal Radiol 29 387-391... 

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