Defination ,cause,sign & symptoms ,managemet

1. DUPUYTREN’S
CONTRACTURE
BY:- Pushpendra yaduvanshi
Asst. prof. Physiotherapy
Career Point University, Kota

2. INTRODUCTION
 Plater first described this condition in 1614,
 But Dupuytren presented a meticulous anatomical
study in 1831 that established the palmar fascia as
the site of origin,

3. Cont…
 It is a relatively common disorder characterized by
progressive fibrosis of the palmar fascia
 Initial tendon thickening is painless and often goes
unnoticed and undiagnosed
 Joint stiffness and a loss of full extension develop
insidiously over decades

4. Cont…
 As the scarring process progresses, nodules form
on the palmar fascia
 The finger gradually loses its flexibility, with
contractures that draw one or more fingers into
flexion at the MCP joint

5. Definition
DUPUYTREN'S CONTRACTURE:-
 A condition marked by fibrosis with shortening
and thickening of the palmar aponeurosis resulting
in flexion contracture of the fingers into the palm
of the hand

6. Dupuytren's contracture Picture

7. Dupuytren's contracture Picture

8. CAUSES
 genetic in origin
 Several studies mostly in Europe and the U.S.
suggest there is an autosomal dominant pattern of
inheritance with variable penetrance

9. Cont…
 HLA-B7 and HLA-DR3 markers have been
identified in a number of patients suggesting a
possible immunologic influence as well
 excessive growth and excessive production of
collagen from the fibroblast cells in the palmar
tissue

10. Cont…
 Trauma of chronic repetitive in nature
 Occupational seen in people employed in rock
drilling due to the vibration of machine

11. Cont…
it occurs more frequently in patients with:-
 diabetes mellitus
 epileptics
 alcoholism

12. Symptoms of Dupuytren
contracture
 Initially may cause only a minor painless lump in
the palm of the hand near the base of the finger
 Most commonly affects the ring (fourth) finger but
it can affect any and all fingers
 It can also affect one or both hands

13. Cont…
 As progresses it can lead to an inability to fully
extend the affected finger from the flexed position

14. Pathophysiology
 The basic pathophysiology of Dupuytren
contracture is fibroblast proliferation and
collagen deposition
 Studies implicate growth factors:-
basic fibroblast growth factor
platelet-derived growth factor and
transforming growth factor-beta

15. Cont…
 These factors show increased expression within the
diseased fascia
 The disease progresses in several stages
 The proliferative stage is characterized by the
development of a nodule or nodules

16. Cont…
 Nodules are composed of fibroblasts and type III
collagen
 The proliferative stage is the most biologically
active phase of disease
 Multiple nodules are common and may be tender
to palpation

17. Cont…
 They are often located near the distal palmar crease but
may be found throughout the palm and even in the digits
 Once the nodules are well-established, the active
contractile, or involutional, stage begins
 Cords begin to develop proximal to the nodules, and
grooves or pits in the skin denote skin fixation to the
underlying fascia

18. Cont…
 myofibroblasts replace fibroblasts as the
predominant cell type, they show morphologic
similarities to fibroblasts and smooth muscle cells
 Myofibroblasts are capable of manufacturing
collagen and causing contraction because they
contain myofibrils within the cells

19. Cont…
 Myofibroblasts also have intercellular connections
to each other, permitting the generation of
synchronized contractile forces
 These cells are found not only within palpable
nodules and cords but also as individual cells or
groups of cells throughout the entire palmar fascia

20. Arrow denotes the typical cords of Dupuytren contracture.
These cords are usually painless. Note the MCP joint contracture

21. Arrow denotes the cord often present in Dupuytren contracture.
MCP joint and proximal IP joint contractures are also present

22. Arrows denote the firm nodules that may be the initial physical
finding in Dupuytren contracture. These nodules may be tender upon
palpation or painful with extension of the corresponding digit.

23. TREATMENT
NON SURGICAL TREATMENT-
 Observation:- It consist of no treatment, with
observation being done at every three month
interval.
 Radiotherapy:- It is given only during the early
fibroblastic phase

24. Cont…
 Enzyme injection (collagenase) to treat
Dupuytren's contracture:-
 This is the most recent addition to Dupuytren's
therapies
 It is characterized by excessive collagen
deposition which appears as cords causing an
extension deficit

25. Cont…
 These finger cords causing MCP and proximal PIP
joint contracture (contracture at the base or middle
joint of a finger) are targeted by a non-operative
method injecting an enzyme Clostridial
collagenase, brand name: Xiaflex
 This enzyme weakens the cord which then, in a
next step, can be pulled and mechanically broken.

26. Cont…
 Bent fingers thus become straight and functional
again

27. Cont…
Needle Aponeurotomy:-
 Needle aponeurotomy is a procedure using no
incisions, a needle is used to separate the
Dupuytren's cords, and restore some or all of
finger motion
 Needle aponeurotomy is most successful in the
earlier stages of Dupuytren's contracture

28. Cont…
 SURGICAL TREATMENT :-Surgery is the
known treatment and is delayed until actual
contracture develop
Surgical method:-
 Subcutaneous fasciotomy
 Partial selective fasciectomy

29. Cont…
 Complete fasciectomy
 Fasciectomy with skin grafting

30. REFERENCES
 Essentials of orthopeadics & applied
physiotherapy. Jayant joshi.
 Essentials of orthopeadics for physiotherapist.
John ebnezar
 www.google.com