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DUPUYTREN'S
DISEASE:
FREQUENTLY ASKED QUESTIONS
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.
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How is it staged or graded? There are a variety of classification systems 10050245 , 9665513, 7521655, 2071079, 3190318, 3963905. A characteristic set of microscopic changes occur 4007638. The disease process includes two structures, the nodule and the cord, which are quite different microscopically and biochemically 3351230, 12849947, 12087679, 12087251, 11599921, 9665511, 7594997, 3138883, 6491814, and early ("proliferative") nodules are biologically different from mature ("involutional") nodules 3958550, 6150573. Dupuytren's nodules represent the early, active form of fibrosis, and are the hard lumps in the palm. Cords develop later; they feel like strings beneath the skin and are responsible for the tethering which results in contractures. Contractures often span several adjacent joints. For affected joints, if bending one joint allows the adjacent joint to be fully straightened and vice versa, the contracture is referred to as a "composite contracture". If an affected joint can not be fully straightened in any hand position, the result is called a "fixed contracture" |
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Tubiana's classification is simple and helpful. It grades the contracture into one of four stages based on the combined angles of contracture of the MCP and PIP joints, and may be applied to both composite and fixed contractures: This angle is illustrated by the blue lines in this diagram:
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