Saturday, 14 March 2015

Dupyterens Contracture

💊1. is a fixed flexion contracture of the hand due to a palmar fibromatosis

💊2. It is an inherited proliferative connective tissue disorder that involves the hand's palmar fascia

💊3. The ring finger and little finger are the fingers most commonly affected.

💊4. The middle finger may be affected in advanced cases, but the index finger and the thumb are not affected as frequently [ V IMP ]

💊5. In patients with this condition, the palmar fascia thickens and shortens so that the tendons connected to the fingers cannot move freely

💊6. Incidence increases after age 40; at this age, men are affected more often than women. Beyond 80 the gender distribution is about even. [ V IMP ]

💊7. The main function of the palmar fascia is to increase grip strength; thus, over time, Dupuytren's contracture decreases patients' ability to hold objects [ V IMP ]

💊8. Patients often report pain, aching and itching. Substance P nerve fibers positively correlate to the 12-fold increase in mast cells in patients

💊9. substance P cells can impact fibroblast proliferation, and is related to Interstitial Cystitis. [ V IMP ]

💊10. Normally, the palmar fascia consists of collagen type I, but in Dupuytren sufferers, the collagen changes to collagen type III, which is significantly thicker than collagen type I. [ V IMP ]

💊11. Treatment is indicated when the so-called table top test is positive. With this test, the patient places his hand on a table. If the hand lies completely flat on the table, the test is considered negative.

💊12. Treatment using radiation therapy begins at an earlier stage. Radiation therapy is most effective when nodules and cords first appear, and before contracture begins.

💊13. Dupuytren's contracture is transferred in the family as a so-called autosomal dominant trait with incomplete penetrance and partial sex-limitation

💊14. the gene for a Dupuytren's contracture is not on an X or Y chromosome (sex chromosome) but on one of the other 44 chromosomes.

💊15. Very rarely, a Dupuytren's contracture occurs in association with an uncommon scarring condition of the penis called Peyronie'sdisease.

💊16. Previous burns or hand injury can lead to scar formation in the palm of the hand that can mimic true a Dupuytren's contracture [ V IMP ]

💊💊17. Most patients with a Dupuytren's contracture require reassurance and stretching exercises with heat application [ V IMP ]

💊18. When the palm is persistently sore with grasping, ultrasound treatments can be helpful. Sometimes local inflammation is best relieved with cortisone injection.

💊19. surgical procedures can remove the scarred tissue to free the fingers and release the tendons. These procedures can return function to a disabled hand

💊20. Sometimes the surgeon can release the scarred tissue by carefully cutting it with a needle. This procedure is referred to as a needle aponeurotomy or needle fasciotomy. [ V IMP ]

💊21. A newer treatment for a Dupuytren's contracture is collagenase (Xiaflex) injection. [ V IMP ]

💊22. Collagenase is an enzyme that breaks up the collagen, which can then loosen the contracted tissue to restore finger mobility. Collagenase is directly injected into the contracted "cord" of scar tissue that causes the Dupuytren's contracture. [ V IMP ]

💊23. The main complication of Dupuytren's contractures is loss of extension of the involved fingers

💊24. A fasciectomy involves removing the thickened connective tissue. There are three variations of the procedure: [ SURGICAL RX ]

💊25. Needle aponeurotomy can be used to treat multiple affected fingers and joints during one setting.

💊26. XIAFLEX is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. It is not known if XIAFLEX is safe and effective in children under the age of 18.

💊27. The most common side effects with XIAFLEX for the treatment of Dupuytren’s contracture include:swelling of the injection site or the handbruising or bleeding at the injection sitepain or tenderness of the injection site or the handswelling of the lymph nodes (glands) in the elbow or armpititchingbreaks in the skinredness or warmth of the skinpain in the armpit

💊28. Before receiving XIAFLEX, tell your healthcare provider if you have had an allergic reaction to a previous XIAFLEX injection, or have a bleeding problem or any other medical conditions. [ V IMP ]

💊29. Tendon rupture is also a risk of needle aponeurotomy [ V IMP ]

💊30. Collagenase is contraindicatedfor patients who are on anticoagulation, but that is not an issue for needle aponeurotomy because the skin stops bleeding quickly after a puncture wound. [ V IMP ]

💊31. Another potential limitation for collagenase would be lymphedema or prior lymph node surgery on the side being treated.

💊32. A percentage of people will have a lymphatic reaction after collagenase injection. The only other issue is a patient who had previous surgery and has implants in that hand.

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