DUPUYTREN'S
DISEASE:
FREQUENTLY ASKED QUESTIONS
AND LINKS TO PUBLISHED STUDIES: FAQS & FACTS
These pages include answers to frequently asked questions regarding
Dupuytren's disease. There is quite a bit known about Dupuytren's, but
because we don't yet have all of the pieces of the puzzle, the bits
that we do know don't all fit tidily together. There are also a fair
number of undocumented urban legends. This page only includes
information which has been investigated and published in recognized
medical journals - the stuff that doctors read. For verification and
more information, this
page links to source material at the National
Library of
Medicine. Browse around! There's quite a bit here to consider.
- Demographics -
How common is Dupuytren's contracture? It
depends on the genetic
makeup of the population. Dupuytren's is estimated to affect 3% of
the US population
2190416.
What areas are most often affected?
- Dupuytren's is a change in normal structures
6099177,
transforming the superficial palmar fascia into cords, and joins fascia
to the undersurface of the skin to form nodules 7071229.
Although resembling a tumor in some ways 6197420,
it is not. The longitudinal (lengthwise) fibers of the superficial
palmar fascia are clinically affected 3068887,
but transverse (sideways) fibers also show chromosomal evidence of
involvement 3414684.
Although only certain regions of the fascia appear affected, the
biochemistry of the entire fascia is abnormal 6197420.
The ring finger is most commonly affected, then the small finger,
and then the thumb (28%)
12531665. Thumb involvement can take many forms 3958553,
7049485,
and usually occurs when other fingers are affected 10050250.
Rarely, the wrist may
be involved
11901473,
9119844 ,
8771479. "Knuckle pads" 3190317,
2943155
on the
dorsal PIP joints are apparently the same process as nodules in the
palm. Although neither produce contractures 6707508,
knuckle pads are associated with more aggressive forms of the disease
1960491. Isolated cords in the fingers may develop between
the proximal phalanx periosteum (bone lining at the base of the finger)
and the flexor tendon sheath at the middle phalanx level 3968392.
Abductor pollicis muscle and tendon involvement may affect small finger
contractures 6512361.
- Normally, the skin is anchored down to the underlying
fascia by many tiny tissue strands running perpendicular down to the
fascia. When the fascia shrinks, these threads pull the skin, and may
result in nodules, dimples, or both contour changes:
- Secondary changes may also
occur. The position of the
finger nerves may be shifted by the growth of a
"spiral cord", especially when the PIP joints become contracted
7822934,
1769988.
Extensor tendons on the back of the finger may be indirectly affected 4015238:
the central slip tendon which straightens the PIP
joint may become stretched out from the joint being bent for a long
time
7806815, and the transverse retinacular ligaments on the
sides
of the joint may become fibrotic, resulting in a boutonniere
deformity
3249131, 3190317.
 - Rarely, the extensor tendons
may be affected by PIP knuckle pads 6693470
or distal to the PIP joint 7119399.
Other changes in the PIP joint may prevent full correction
of contracture 4078465
using surgical techniques which work for
non-Dupuytren's PIP contractures
1779164. Bone spurs may develop
in the finger bones as a result of tension on the attachments to
bones
11982519,
10433443. Rarely, the DIP joints
are involved
1773223.
- Outside the hand, the sole of the
foot (Ledderhose's disease) and the penis (Peyronie's Disease) may be
affected in a similar fashion. The combination of all three conditions
- Dupuytren's diathesis, Ledderhose's contracture
and Peyronie's disease - is referred to as Dupuytren's
diathesis 8817754
and is associated with a particularly aggressive condition.
|
