Epidemiology Dupuytren also known as Viking’s disease
|Dupuytren||The tissue that is affected by Dupuytren’s disease is a thin layer of connective tissue just below the skin in the palm. Under this layer lay the tendons, blood vessels and nerves of the hand. Certain cells in this layer, the myofibroblasts, begin to grow and produce connective tissue.
This tissue is very similar to scar tissue, and has a tendency to pull together. This puts the fingers into a flexed position and makes extension becomes less.1
|Incidence||The disease is mainly found in northern Europe. At 4% of the population in England. The percentage increases as you change the age of the population.3
The incidence rate for the British population in 2004 was calculated as 34.4 per 100,000 men between the ages of 40 and 84 years with a gradual increase in incidence with increasing age.4
|Sex||The disease is twice as common in men than in women.
The male to female ratio of dupuytren varies between 7:1 and 15:1 and women tend to suffer more postoperative complications.7 Females are older at the time of their first operation and have a higher recurrence rate and heritability5 compared to males.6
|Age||Morbus Dupuytren is common in 20% of the english population older than 65 years. The incidence of Dupuytren’s contracture increases with age.3|
|Pain location||Hand, handpalm and fingers1|
|Pain sensation/ Symptoms||The condition often occurs bilaterally, there is no relationship with the dominance of the hand. The ring finger is most frequently affected, followed by the little finger.3|
|Prognosis||The course of the disease is unpredictable. Sometimes slow progressive, sometimes rapidly with significant contracture. Young age of the manifestation of the disease, woman, strong family history, bilateral and extensive degradation are often poor prognostic signs. It is important to do a surgical procedure at the right time. Certainly not too early, as the nodules are formed. As long as the hand can still be flat on the table there is usually no indication for surgery.2
It is generally assumed that there is an indication for the operation when:
– More than 30° contracture of the MCP joints.
– More than 0° contracture of the PIP joints. 2
|History of injury||Hand trauma and a history of manual labor are an integral part of establishing whether they are causes of disease development with suggestions that DD is, in certain cases, precipitated or aggravated by hand injury, hand infection, elective hand surgery8,10,11, and vibration exposure.9|
|Risk factors||Dupuytren is a condition which has been linked to many risk factors including a history of smoking12, alcohol consumption13, frozen shoulder14, epilepsy15, diabetes mellitus16, carpal tunnel syndrome17, history of manual labor18, and hand injury.19,20|
|Nowadays, there is often made use of the scale according to Bulstrode1
1. Only nodules and cords
2a. Contracture <45 ° in any joint
2b. Contracture> 45 °
2c. Contracture> 60 ° in PIP
2d. Central slip tendon damage (short stem)
2e. A vascularity in extension
|The power of the hand is measured with the Jamar dynamometer.10,11
The intra- and inter-tester reliability results for handgrip and indexgrip strength measured with the Jamar dynamometer were almost perfect (ICC values 0.85-0.98).
|Filling in the DASH questionnaire.
These are 30 questions where a 1-5 score can be given. 30 points for normal function of the hand. 150 is a total inability to of the hand function.
The reliability and validity of the DASH questionnaire demonstrated excellent test-retest reliability (ICC = 0.96) in 86 patients. The DASH correlated with other measures of pain and functional limitations (r> 0.69).12
|The Visual Analoge Scale (VAS)
Studies that examined the correlation between a vertically oriented VAS for pain with a horizontally oriented VAS found correlations of 0.99 and 0.91 when they were given within 10 minutes of each other2,3
The VAS is generally regarded as a valid and reliable tool for chronic pain measurement.2–5
Although it appears to be equally valid in acute pain measurement,6–8
The minimum clinically significant difference in pain (approximately 13 mm). This is consistent with the findings of DeLoach et al., who reported that 95% of the differences between acute
postoperative pain measured 3 minutes apart were within 618 mm.9
The Kappa is measured in population with chronic low back pain as KW=0.7013
The minimum clinically significant difference in pain by Hagg et al. is approximately18-19mm.14
|The Range of motion (ROM) is measured by the Goniometer
According to Currier, a correlation of 0.80 to 1.00 is considered very reliable.15
The intertester reliability of the universal(standard) and fluid-based goniometers was 0.87 and 0.83, respectively. Rothstein et al also reported good intertester reliability for the standard goniometer.16
|The Allen test is a widely used screening method of hand circulation.
Sensitivity of the Allen test is 73.2% and specificity 97.1%.17