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Sunday, December 14, 2014

Dupuytren's Contracture Disease

What is dupuytren's contracture ?


Dupuytren's disease or fibromatosis facial palmaris is a condition where a strong strand of connective tissue in the palm (aponeurosis palmaris) of the ring finger, middle finger or little finger is. The disorder was described by Baron Guillaume Dupuytren in 1831. Although he was not the first to describe this condition, he was the first to contracture in the aponeurosis palmaris localized. To date, the cause of the disease is unknown. The disease could be prevented if the Celts, hence is also spoken about the "Celtic claw".

Dupuytren's disease is most common in North-European peoples, while it is uncommon among African peoples. This is often assumed that there is a genetic predisposition for the disease. It is also called the Viking disease because of the geographical spread of the disease across Europe and Britain corresponds to the Viking Hiking. In 2008, a large genetic study was conducted to Dupuytren's disease.

The disease begins with a nodule in the palm. Sometimes the string occurs within a few months, sometimes it can take years for the disease worsens. This strand pulls the finger crooked, eventually fingers can not move. Usually, the disease develops at the ring finger or little finger (or both), but it can occur at all five fingers (or a combination thereof).

Similar conditions can also occur in other body parts, such as the foot disease (Ledderhose), plantar fascia, or on the penis shaft (Peyronie's disease).

The disease usually occurs after the age of 40. Men get Dupuytrens disease more often than women. Often the condition on both the hands at the same time (bilateral). A more aggressive form of the disease (and higher risk of recurrence and / or expansion) is associated with an early age of onset, positive family history, bilateral (hands) and ectopic disease (such as Peyronie's disease or Ledderhose). The disease is also associated with epilepsy, diabetes, toil, excessive alcohol consumption, smoking and elevated cholesterol.

Dupuytren's disease can be treated surgically. An operative treatment is not directed to the elimination of the disease, but at restoring hand function. An often used criterion is the patient or his or her hand can lay flat on the table. A frequently used operation is fasciectomy. Here, the skin is opened and the affected tissue (fascia) plus removed a small margin. There are also less-invasive surgical treatments. For example, it is done at the University Medical Centre Groningen study of needle-aponeurotomie eluting with a needle, the strands are cut by the skin. The advantage of this technique is that it is faster recovery after surgery. The disadvantage is that the curvature could come back faster. Erasmus MC in Rotterdam is currently underway with a new needle method in combination with the injection of autologous fat to delay the recurrence of the disease as much as possible. This is used in the first surgery and is currently being examined how effective it is in people who have already had surgery one or two times before.

Rehabilitation after fasciectomy can last long, especially performed in people with work involving heavy labor with their hands. In minimally invasive techniques, this rehabilitation considerably shorter. Often, however, the disease return, sometimes after a few months, sometimes after several decades. If several times to be operated on, the chance to take on nerve damage.

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