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26 Cards in this Set
- Front
- Back
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What geographic populations are at the highest risk?
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Northern Europeans
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Inheritance pattern?
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Autosomal dominant
Sporadic (majority) |
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Penetrance?
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Variable
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What gender is most at risk of developing Dupuytren’s disease?
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Male
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What are the three stages of Dupuytren’s disease?
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Proliferative
Involutional Residual |
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What are the proliferative phase features: Key cells? Matrix? Gap junctions? Vascularity?
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Large myofibroblasts
Minimal extracellular matrix High number of gap junctions High vascularity |
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What are the features of the involutional stage: Key cells? Collagen types?
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Dense myofibroblasts
High ratio of type III to type I collagen |
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What are the features of the residual phase?
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Fibrosis
Acellular No nodules |
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ls Dupuytren’s generally a volar or dorsal process?
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Volar
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What ligamentous structure is generally spared: Cleland’s or Grayson's?
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Cleland
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What structures are generally involved?
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Pretendinous bands
Spiral bands (at the MCP joint) Natatory ligament Grayson’s Lateral digital sheath |
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What are the components of the spiral cord?
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Pretendinous bands
Spiral band Grayson's Lateral digital sheath |
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What commonly tested structure is not a component of the spiral cord?
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Natatory ligament
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What is the position of the spiral cords in relation to the neurovascular bundles?
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Spiral cords are deep to the
neurovascular bundles |
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What is the significance of this anatomic relationship?
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Neurovascular bundles are pushed volarly and toward the midline
At increased risk with surgical intervention |
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What is the best predictor of the degree of neurovascular bundle displacement?
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Magnitude of PIP contracture
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Corticosteroid injections are proven effective for what Dupuytren’s structures?
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Nodules not associated with cords
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What are the surgical indications for Dupuytren’s disease?
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MCP joint contracture >30 degrees
PIP joint contracture |
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What is the preferred surgical intervention?
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Regional palmar fasciotomy of the affected digit
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What about total palmar fasciotomy? Why not?
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No longer favored procedure
Palm sensitivity |
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Should carpal tunnel release be performed with Dupuytren’s surgery? Why?
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No concomitant carpal tunnel release
Increased flare reaction |
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What is the preferred management of the surgical incision?
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Leave the transverse component of Z-plasty incisions open
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What if the PIP contracture >40 degrees?
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15-to 20-degree flexion contracture favored over PIP instability
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What are the long-term outcomes of Dupuytren’s releases at the MCP joint and the PIP joint?
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MCP correction tends to be maintained
PIP contracture tends to recur |
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Complications are associated with what clinical conditions?
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Alcoholism
Seizure disorder Diabetes mellitus |
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Before any revision Dupuytren’s surgery, what test is critical to perform?
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Allen test
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