Epidemiology Dupuytren also known as Viking’s disease

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
Literature
  1. Bulstrode N. W., M. Bisson, B. Jemec, A. L. Pratt, D. A. Mcgrouther and A. O. Grobbelaar. A Prospective randomised clinical trail of the intra-operative use of 5- fluorouracil on the outcome of dupuytren’s disease. Journal of Hand Surgery (British and European Volume, 29B: 1: 18– 21 (2004)
  2. Roush Thomas F., BA, Peter J. Stern, MD, Cincinnati. Results Following Surgery for Recurrent Dupuytren’s Disease. J Hand Surg; 25A:291–296. (2000)
  3. Hart M.G., Hooper G. Clinical association of Dupuytren’s disease. Postgrad Med J; 81:425-428. (2005)
  4. Khan AA, Rider OJ, Jayadev CU, Heras-Palou C, Giele H, Goldacre M. The role of manual occupation in the etiology of Dupuytren’s disease in men in England and Wales. J Hand Surg [Br] 2004;29(1):12-4.
  5. Hindocha S, John S, Stanley JK, Watson SJ, Bayat A. The Heritability of Dupuytren’s Disease: Familial Aggregation and Its Clinical Significance. J Hand Surg [Am] 2006. 31(2):204–10. doi:10.1016/j.jhsa.2005.09.018.
  6. Wilbrand S, Ekbom A, Gerdin B. The sex ratio and rate of re-operation and rate of reoperation for Dupuytren’s contracture in men and women. J Hand Surg [Br] 1999. 24(4):456–9. doi:10.1054/jhsb.1999.0154.
  7. Zemel NP. Dupuytren’s contracture in women. Hand Clin 1991;7(4):707-11.
  8. 1. Abe Y, Rokkaku T, Ebata T, et al. Dupuytren’s disease following acute injury in Japanese patients: Dupuytren’s disease or not? J Hand Surg [Br] 2007. 32(5):569–72. doi:10.1016/j.jhse.2007.06.005.
  9. Liss GM, Stock SR. Can Dupuytren’s contracture be work related?: review of the evidence. Am J Ind Med 1996. 29(5):521–32. doi:10.1002/(SICI)1097-0274(199605)29:5<521::AID-AJIM12>3.0.CO;2-2..
  10. 58. Lucas G, Brichet A, Roquelaure Y, Leclerc A, Descatha A. Dupuytren’s disease: Personal factors and occupational exposure. Am J Ind Med 2008. 51:9–15. doi:10.1002/ajim.20542.
  11. 72. Mikkelsen OA. Dupuytren’s disease—the influence of occupation and previous hand injuries. Hand 1978. 10(1):1-8. doi:10.1016/S0072-968X(78)80019-9.
  12. 14. Burge P, Hoy G, Regan P, Milne R. Smoking, alcohol and the risk of Dupuytren’s contracture. J Bone Joint Surg 1997;79(B):206-10.
  13. Noble J, Arafa M, Royle SG, McGeorge G, Crank S. The association between alcohol, hepatic pathology and Dupuytren’s disease. J Hand Surg [Br].1992;17(1):71-4.
  14. Smith SP, Devaraj VS, Bunker TD. The association between frozen shoulder and Dupuytren’s disease. J Shoulder Elbow Surg 2001. 10(2):149–51. doi:10.1067/mse.2001.112883.
  15. Mikkelsen OA. Dupuytren’s disease-initial symptoms, age of onset and spontaneous course. Hand 1977. 9(1):11–5. doi:10.1016/S0072-968X(77)80023-5.
  16. Arkkila PE, Kantola IM, Viikari JS. Dupuytren’s disease: Association with chronic diabetic complications. J Rheumatol 1997;24:153-9.
  17. Bonnici AV, Birjandi F, Spencer JD, Fox SP, Berry AC. Chromosomal abnormalities in Dupuytren’s contracture and carpal tunnel syndrome. J Hand Surg [Br] 1992. 17(3):349–55. doi:10.1016/0266-7681(92)90128-O.
  18. de la Caffiniere JY, Wagner R, Etscheid J, Metzger F. Manual labour and Dupuytrens disease. The results of a computerized survey in the field of iron metallurgy. Ann Chir Main 1983. 2(1):66–72. doi:10.1016/S0753-9053(83)80084-2.
  19. Kelly SA, Burke FD, Elliot D. Injury to the distal radius as a trigger to the onset of Dupuytren’s disease. J Hand Surg [Br] 1992. 17B:225–9. doi:10.1016/0266-7681(92)90096-K.
  20. McFarlane RM. Dupuytren’s disease: relation to work and injury. J Hand Surg [Am] 1991;16:775–9.

 

Physical examination

Pathology  
 
  1. Growthofmyofibroblasts, withformation oflumps(nodules) inthe palmwhichsometimes can bepainful.
 
  1. Formation ofconnective tissuestrandswith progressivecontractureofthefinger, usuallythepinky andring finger.
 
  1. End stage, withhardstrands andrestricted movementof the fingers.
Classification1
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.25

Although it appears to be equally valid in acute pain measurement,68

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

Literature
  1. Bulstrode N.W., Jemec B., Smith P.J. The complications of Dupuytren’s contracture surgery. J Hand Surg;30A:1021-1025 (2005)
  2. Downie WW, Leatham PA, Rhind VW, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978; 37:378–81.
  3. Scott J, Huskisson EC. Vertical or horizontal visual analogue scales. Ann Rheum Dis. 1979; 38:560.
  4. McCormack HM, Horne DJL, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med.1988; 18:1007–19.
  1. Gaston-Johansson F. Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices. J Pain Symptom Manage. 1996; 12:172–81.
  1. Todd KH, Funk KG, Funk JP, Bonacci R. Clinical significance of reported changes in pain severity. Ann Emerg Med. 1996; 4:485–9.
  2. Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998; 11:1086–90.
  3. Libman M, Berkoff D, Lahn M, Bijur P, Gallagher EJ. Independent validation of the minimum clinically important change in pain scores as measured by visual analog scale [abstract]. Acad Emerg Med. 2000; 7:550.
  4. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth 1998; 86:102–6.
  5. Hamilton A, Balnave R, Adams R. Grip strength testing reliability. J Hand Ther; 7: 163–170 1994.
  6. Lusardi M, Bohannon R. Hand grip strength: comparability of measurements obtained with a Jamar dynamometer and a modi.ed sphygmomanometer. J Hand Ther; 4: 117–122 1991.
  7. Beaton, D. E., Katz, J. N., Fossel, A. G., Wright, J. G., Tarasuk,V., & Bombardier, C. (2001). Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand Outcome Measure in different regions of the upper extremity. Journal of Hand Therapy, 14 (2), 128-146.
  8. Staes F, Stappaerts K, Vertommen H, Everaert D, Coppieters M. reproducibility of a survey questionnaire for the investigation of low back problems in adolescents. Acta Paediatr 1999;88(11):1269-1273
  9. Hagg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 2003:12(1)12-20
  10. Currier DP: Elements of Research in Physical Therpy, ed 2. Baltimore, MD, Williams & Willkins, 1984, pp 156-166
  11. Rothstein JM, Miller PJ, Roettger RF: Goniometric reliability in a clinical setting: Elbow and knee measurements. Phys Ther 63:1611- 1615, 1983
  12. Kohonnen K et al. Is the Allen test reliable enough? Eur J Cardiothorac Surg (2007) 32 (6): 902-905.doi:10.1016/j.ejcts.2007.08.017

 

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