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Diagnosis and Treatment of Dupuytrens Disease

Dupuytren's contracture (palmar fibromatosis) is umbilicus change of the fascia, which covers the tendon, and shortening of palmar tendons, leading to flexion strain and loss of ability to fully unbend the fingers. Most often, the process affects the function of the ring finger or the little finger, but the dupuytrens disease can affect all the fingers of the hand or fingers of both hands.

At the young age, this disease is quite rare, but over the years, the incidence of Dupuytren's contracture increases. The incidence of Dupuytren's contracture in men is several times higher than in women. The most common Dupuytren's contracture occurs in middle-aged men. If the disease occurs at a young age, then generally it is characterized by a rapid progression of symptoms and severity of disease.

Dupuytren's contracture may appear at first only a painless lump in the palm of your hands near the base of fingers. Usually the scar is affected only a small portion of the palmar Apo neurosis in one hand. In case of treatment absence, the disease progresses. In most cases, severe symptoms appear only after a few years after onset. Dupuytren's contracture in men tends to be more rapid progression of the disease than in women.

Diagnosis

The diagnosis is made orthopedic trauma based on complaints about limitations of the disease, the effect of the presence of contractures in the quality of life. Most likely, you will be asked about smoking, alcohol consumption, the presence of cases of Dupuytren's contracture in the immediate family. Also carried out inspection of hands, palpation, and examination of the mobility of fingers. On palpation of the brush, your doctor may determine the thickening of the palmar fascia in the form of dense strands or nodules. In the initial stages of the disease, such nodules are found, usually in the palm of your hand. In the later stages of the disease connective tissue nodules can be located in the fingers. We estimate the amplitude of flexion and extension of fingers. In the presence of Dupuytren's contracture, extension of one or more fingers is difficult. In advanced cases of motion in the joints of the fingers raised in the process, it is impossible. For the diagnosis in most cases, additional laboratory and instrumental methods is not required.

Developmental stages of Dupuytren's contracture

Grade I shows the presence of subcutaneous seal on the palm, which does not limit extension of the fingers and does not interfere with the patient in everyday life. At this stage of the disease, there are no significant abnormalities in the hands and surgical treatment is usually not performed.

Grade II - the restriction of passive extension of the finger 300. A relatively small restriction of the brush, as often is not in the eyes of the patient base for operations. However, the radical Aponevrectomy at this stage of extension of the fingers can be fully restored.

Grade III - extension deficit of thumb is 300 to 900. Due to the high prevalence of surgical treatment of the process is sometimes very difficult. Straightening the finger in full extension position often requires volar capsulotomy. When the operation sometimes there is a deficiency of the skin, excessive tension neurovascular bundles fingers. Surgical treatment at this stage does not always lead to full restoration of extension of fingers.

Grade IV is characterized by the degree of involvement in the pathological process of tendon and articular structures of the apparatus, and the deficit exceeds the extension of the finger 900. Surgical treatment has limited effectiveness and often involves such radical surgery as corrective arthrodesis of the finger joints.

Treatment of contractures can be both conservative and surgical methods. The main reason for choosing a method of treatment is the severity of pathological changes. Treatment of Dupuytren's contracture is engaged in an orthopedic surgeon, a trauma.

Conservative therapy

Conservative treatment for early stage Dupuytren's contracture.

Massage.

Gymnastics aimed at stretching the palmar fascia.

Physical therapy.

The position correction using splints or plaster bandages (fixing fingers in the position of extension). As a rule, used bandages longetnye during sleep.

Warm baths.

Injections of corticosteroids (at a local inflammation).

Conduct of conservative therapy can slow the progression of the disease; increase the degree of the fingers, but sooner or later the question of the need for surgery. If the operation is performed in young patients at the severe contraction, then a few years or decades may experience a relapse, which would require re-operation.

Surgical treatment of

As a general rule, surgery may be recommended by orthopedic trauma surgeon, if the angle of flexion of the finger reaches 30 degrees. If the operation is performed in young patients at the severe contraction, then a few years or decades may experience a relapse, which would require re-operation. The operation is in most cases a partial or almost complete excision of the palmar fascia and fibrous cords that connect the fascia to other tissues brush. Because of this operation, most patients have a positive effect, restored the movement of fingers in full.

Aponevrectomy is the most common radical treatment, the technique is quite complicated. The surgeon must have an accurate understanding of emerging issues in the operation and how best to address them. The basic principles of Aponevrectomy are:

correct choice of surgical approach;

radical removal of abnormal tissue;

prevention of nerve damage hand;

maintain sufficient blood supply to the fingers;

plastic appearing skin blemishes;

prevention of circulatory disorders of the skin flaps formed;

prevention of bruising;

the best way to close the wound.

Surgery is performed under local or general anesthesia. Previously conducted training with the palm of enzymes and physical therapy, because otherwise during the operation it will be difficult to separate the skin and located below the scar tissue bands.

When properly executed operation and preoperative skin frequently eliminates the need excision of the skin and free skin plasty. In itself, however well executed operation does not give reason to hope for a good outcome. The best positive result is achieved only when the consistent implementation of the preoperative preparation, surgery and postoperative recovery of the complex.

In rehabilitation after surgery using the previously functional treatment, dosage of motion, massage, physiotherapy and heat and electric. Recovery of lost functions after surgery and hand rehabilitation provides a full return of quality of life.