Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Sep 16, 2011.
Answer : Dupuytren's contracture
Dupuytren's contracture ()
Initial therapy for a patient with a functionally significant Duputryren's contracture is
(A) Physical therapy
(B) Steroid injection
Go for it guys (-:
Well, I See no answers coming. So I will go ahead and keep the ans.
Most nonoperative management techniques will not delay the progression of disease.
Corticosteroid injections may soften nodules and decrease discomfort associated with them, but are ineffective against cords.
Splinting similarly has been shown not to retard disease progression.
Injectable clostridial collagenase has shown promise in clinical trials but has not yet been reported in large or long-term series. It also is not yet commercially available.
For patients with advanced disease, including contractures of the digits that limit function, surgery is the mainstay of therapy.
Although rate of progression should weigh heavily in the decision of whether or not to perform surgery, general guidelines are MP contracture of 30Â° or more and/or PIP contracture of 20Â° or more.
Ref - (See Schwartz 9th ed., Chapter 44, Surgery of the Hand and Wrist.)
Some technical Aspects related to Surgery
Percutaneous Needle aponeurectomy is the procedure of choice and should be done by a hand surgeon as there may be variations in the anatomy of neuro-vascular structures sec to Dupytren.
Secondly while performing the release pick a spot over the contracture with loose skin, becos otherwise the skin will not stretch and the results will be poor. Then we will unnecessarily needle in that area further which will lead to skin tearing, further scarring and needless to say further contracture.
Use smaller gauge needles for digital cords - generally 25 g for digital cords and 23 g for palmar cords.
only anesthetise the skin becos the patient's perception of nerve irritation is imp to prevent digital nerve injury !!!
Precaution : Following the procedure the patient is advised to avoid very tight gripping activities as it can recur. Also the patient should be warned that this can recur in the same spot or anywhere else in either hand. Don't give any unrealistic expectations wink)
Caution : Also if there is scar from previous surgery then this procedure does not hold very good promise and the disturbed neuro-vascular anatomy will be in further danger.
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