Needle aponeurotomy for dupuytren’s contracture of hand with extended physical therapy and serial intralesional steroid injections
Keywords:
Percutaneous needle fasciotomy, Dupuytren’s contracture, Needle aponeurotomy, Intralesional corticosteroid injection, Extended physical therapy hand
Abstract
Background: Dupuytren’s disease is common benign proliferative disorder of the palmer fascia and is a part of a group of fibromatosis that includes planter fibromatosis (Ledderhose disease) and penile fibromatosis (Peyronie’s disease). It tends to present in sixth and seventh decade of life but can present earlier or later.
Method: we recruited eleven patients with Dupuytren’s contracture of hand in the present study. Percutaneous release of the Dupuytren’s band was performed under local anesthetic agent with an 18 Gauze needle in outpatient department. Postoperatively all patients underwent the programme of extended vigorous physical therapy of the hand and series of triamcinolone injections at 4 monthly interval for 1 year.
Result: In our study all patients were males in the age range of 48 to 78 years. Commonly involved finger was the ring finger in six patients followed by little finger in three and middle finger in two. Nine patients had right finger affected and in rest two left side fingers were affected. All patients did well and there was no recurrence of contracture in any patients during the study period. One patient experienced unexplained chronic pain in the finger. Postoperatively range of motion improved significantly after 18 months of follow-up.
Conclusion:Percutaneous needle aponeurotomy with extended post-operative physical therapy and serial 4 monthly intralesional steroid injections in Dupuytren’s contracture is reliable and relatively simple to perform compared to partial aponeurectomy. This regime of treatment could be seen as a serious alternative for selected cases.
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References
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2.Hu FZ, Nystrom A, Ahmed A, Palmquist M, Dopico R, Mossberg I, et al. Mapping of an autosomal dominant gene for Dupuytren's contracture to chromo-some 16q in a Swedish family. Clinic Gen. 2005; 68(5): 424-429. doi: 10.1111/j.1399-0004.2005. 00504.x
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6. Early PF. Population studies in Dupuytren's contracture. The Journal of Bone and Joint Surgery. British volume. 1962; 44 (3): 602-613.
7. Stahl S, Calif E. Dupuytren's palmar contracture in women. Isr Med Assoc J. 2008;10(6):445-447.
8. Burge P, Hoy G, Regan P, Milne R. Smoking, alcohol and the risk of Dupuytren's contracture. J Bone Joint Surg Br. 1997;79(2):206-210. doi:10.1302/0301-620x.79b2.6990
9.Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R.Dupuytren's disease risk factors. J Hand Surg Br. 2004;29(5):423-426. doi:10.1016/j.jhsb.2004. 06.006
10. Hindocha S, Stanley JK, Watson JS, Bayat A. Revised Tubiana's staging system for assessment of disease severity in Dupuytren's disease-preliminary clinical findings. Hand (NY). 2008; 3(2): 80-86. doi: 10. 1007/ s11552-007-9071-1. Epub 2007 Sep 11.
11. Finney R. Dupuytren's contracture. Br J Radiol. 1955; 28 (335): 610-614. doi:10.1259/0007-1285-28- 335-610
12. Lukacs S, Braun‐Falco O, Goldschmidt H. Radio-therapy of benign dermatoses: indications, practice, and results. J Dermatol Surg Oncol. 1978;4(8): 620-625. doi:https: //doi.org/ 10.1111/j. 1524-4725.1978.tb00512.x
13.Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg Am. 2000;25(6):1157-1162. doi: 10.1053/ jhsu. 2000.18493
14. Lermusiaux JL, Lellouche H, Badois JF, Kuntz D. How should Dupuytren's contracture be managed in 1997? Rev Rhum Engl Ed. 1997;64(12):775-776.
15. Skov ST, Bisgaard T, Søndergaard P, Lange J. Injectable Collagenase Versus Percutaneous Needle Fasciotomy for Dupuytren Contracture in Proximal Interphalangeal Joints: A Randomized Controlled Trial.J Hand Surg Am. 2017;42(5):321-328.e3. doi: 10.1016 /j.jhsa. 2017.03.003.
16. Shih B, Bayat A. Scientific understanding and clinical management of Dupuytren disease. Nat Rev Rheumatol. 2010;6(12):715-726. doi: 10.1038/nrrheum. 2010. 180. Epub 2010 Nov 9.
17. Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA, et al. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009;361(10):968-979. doi: 10.1056/ NEJ Moa 0810866.
18. van Rijssen AL, ter Linden H, Werker PM. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg. 2012; 129(2): 469-477. doi: 10.1097/PRS.0b013e31823aea95.
19. Mickelson DT, Noland SS, Watt AJ, Kollitz KM, Vedder NB, Huang JI. Prospective randomized controlled trial comparing 1- versus 7-day manipulation following collagenase injection for dupuytren contracture. J Hand Surg Am. 2014; 39(10):1933-1941. e1.doi: 10.1016/j.jhsa.2014.07.010.Epub 2014 Sep 4.
20. Molenkamp S, Schouten TAM, Broekstra DC, Werker PMN, Moolenburgh JD. Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease. Plast Reconstr Surg. 2017;139(6):1415-1421.doi:10.1097/PRS.000000 00 00 003357.
21. Houshian S, Jing SS, Chikkamuniyappa C, Kazemian GH, Emami-Moghaddam-Tehrani M. Management of posttraumatic proximal interphalangeal joint contracture. J Hand Surg Am. 2013;38(8):1651-1658. doi: 10.1016/j.jhsa.2013.03.014. doi:10.1016/j. jhsa. 2013.03.014
22.Verjee LS, Midwood K, Davidson D, Essex D, Sandison A, Nanchahal J. Myofibroblast distribution in Dupuytren's cords: correlation with digital contracture. J Hand Surg Am. 2009;34(10):1785-1794. doi: 10.1016/j.jhsa.2009.08.005. Epub 2009 Nov 11.
23. Strömberg J, Vanek P, Fridén J, Aurell Y. Ultra-sonographic examination of the ruptured cord after collagenase treatment or needle fasciotomy for Dupuytren's contracture. J Hand Surg Eur Vol. 2017;42 (7): 683-688. doi: 10.1177/1753193417711594. Epub 2017 Jun 6.
24. Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg Am. 2000;25(6):1157-1162. doi:10.1053/jhsu.2000.18493
25. Nydick JA, Olliff BW, Garcia MJ, Hess AV, Stone JD. A comparison of percutaneous needle fasciotomy and collagenase injection for dupuytren disease. J Hand Surg Am. 2013;38(12):2377-2380. doi: 10.1016/j.jhsa. 2013. 08.096. Epub 2013 Sep 20.
26. Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am. 2012;37(4):651-656. doi: 10. 1016/j.jhsa.2012.01.029.
27. Strömberg J, Ibsen-Sörensen A, Fridén J. Comparison of Treatment Outcome After Collagenase and Needle Fasciotomy for Dupuytren Contracture: A Randomized, Single-Blinded, Clinical Trial With a 1-Year Follow-Up. J Hand Surg Am. 2016;41(9):873-880. doi: 10.1016/j.jhsa.2016.06.014. Epub 2016 Jul 27.
28. Denkler K. Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature. Eplasty. 2010;10:e15.
2.Hu FZ, Nystrom A, Ahmed A, Palmquist M, Dopico R, Mossberg I, et al. Mapping of an autosomal dominant gene for Dupuytren's contracture to chromo-some 16q in a Swedish family. Clinic Gen. 2005; 68(5): 424-429. doi: 10.1111/j.1399-0004.2005. 00504.x
3. Elliot D. The early history of contracture of the palmar fascia. Part 1: The origin of the disease: the curse of the Mac Crimmons: the hand of benediction: Cline's contracture. J Hand Surg Br. 1988;13(3): 246-253. doi:10.1016/0266-7681(88)90078-2
4. Townley WA, Baker R, Sheppard N, Grobbelaar AO. Dupuytren's contracture unfolded. BMJ. 2006;332 (7538): 397-400. doi:10.1136/bmj.332.7538.397
5.Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T. Epidemiology of Dupuytren's disease: clinical, serological, and social assessment. The Reykjavik Study. J Clin Epidemiol. 2000; 53(3):291-296. doi:10.1016/s0895-4356(99)00145-6
6. Early PF. Population studies in Dupuytren's contracture. The Journal of Bone and Joint Surgery. British volume. 1962; 44 (3): 602-613.
7. Stahl S, Calif E. Dupuytren's palmar contracture in women. Isr Med Assoc J. 2008;10(6):445-447.
8. Burge P, Hoy G, Regan P, Milne R. Smoking, alcohol and the risk of Dupuytren's contracture. J Bone Joint Surg Br. 1997;79(2):206-210. doi:10.1302/0301-620x.79b2.6990
9.Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R.Dupuytren's disease risk factors. J Hand Surg Br. 2004;29(5):423-426. doi:10.1016/j.jhsb.2004. 06.006
10. Hindocha S, Stanley JK, Watson JS, Bayat A. Revised Tubiana's staging system for assessment of disease severity in Dupuytren's disease-preliminary clinical findings. Hand (NY). 2008; 3(2): 80-86. doi: 10. 1007/ s11552-007-9071-1. Epub 2007 Sep 11.
11. Finney R. Dupuytren's contracture. Br J Radiol. 1955; 28 (335): 610-614. doi:10.1259/0007-1285-28- 335-610
12. Lukacs S, Braun‐Falco O, Goldschmidt H. Radio-therapy of benign dermatoses: indications, practice, and results. J Dermatol Surg Oncol. 1978;4(8): 620-625. doi:https: //doi.org/ 10.1111/j. 1524-4725.1978.tb00512.x
13.Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg Am. 2000;25(6):1157-1162. doi: 10.1053/ jhsu. 2000.18493
14. Lermusiaux JL, Lellouche H, Badois JF, Kuntz D. How should Dupuytren's contracture be managed in 1997? Rev Rhum Engl Ed. 1997;64(12):775-776.
15. Skov ST, Bisgaard T, Søndergaard P, Lange J. Injectable Collagenase Versus Percutaneous Needle Fasciotomy for Dupuytren Contracture in Proximal Interphalangeal Joints: A Randomized Controlled Trial.J Hand Surg Am. 2017;42(5):321-328.e3. doi: 10.1016 /j.jhsa. 2017.03.003.
16. Shih B, Bayat A. Scientific understanding and clinical management of Dupuytren disease. Nat Rev Rheumatol. 2010;6(12):715-726. doi: 10.1038/nrrheum. 2010. 180. Epub 2010 Nov 9.
17. Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA, et al. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009;361(10):968-979. doi: 10.1056/ NEJ Moa 0810866.
18. van Rijssen AL, ter Linden H, Werker PM. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg. 2012; 129(2): 469-477. doi: 10.1097/PRS.0b013e31823aea95.
19. Mickelson DT, Noland SS, Watt AJ, Kollitz KM, Vedder NB, Huang JI. Prospective randomized controlled trial comparing 1- versus 7-day manipulation following collagenase injection for dupuytren contracture. J Hand Surg Am. 2014; 39(10):1933-1941. e1.doi: 10.1016/j.jhsa.2014.07.010.Epub 2014 Sep 4.
20. Molenkamp S, Schouten TAM, Broekstra DC, Werker PMN, Moolenburgh JD. Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease. Plast Reconstr Surg. 2017;139(6):1415-1421.doi:10.1097/PRS.000000 00 00 003357.
21. Houshian S, Jing SS, Chikkamuniyappa C, Kazemian GH, Emami-Moghaddam-Tehrani M. Management of posttraumatic proximal interphalangeal joint contracture. J Hand Surg Am. 2013;38(8):1651-1658. doi: 10.1016/j.jhsa.2013.03.014. doi:10.1016/j. jhsa. 2013.03.014
22.Verjee LS, Midwood K, Davidson D, Essex D, Sandison A, Nanchahal J. Myofibroblast distribution in Dupuytren's cords: correlation with digital contracture. J Hand Surg Am. 2009;34(10):1785-1794. doi: 10.1016/j.jhsa.2009.08.005. Epub 2009 Nov 11.
23. Strömberg J, Vanek P, Fridén J, Aurell Y. Ultra-sonographic examination of the ruptured cord after collagenase treatment or needle fasciotomy for Dupuytren's contracture. J Hand Surg Eur Vol. 2017;42 (7): 683-688. doi: 10.1177/1753193417711594. Epub 2017 Jun 6.
24. Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg Am. 2000;25(6):1157-1162. doi:10.1053/jhsu.2000.18493
25. Nydick JA, Olliff BW, Garcia MJ, Hess AV, Stone JD. A comparison of percutaneous needle fasciotomy and collagenase injection for dupuytren disease. J Hand Surg Am. 2013;38(12):2377-2380. doi: 10.1016/j.jhsa. 2013. 08.096. Epub 2013 Sep 20.
26. Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am. 2012;37(4):651-656. doi: 10. 1016/j.jhsa.2012.01.029.
27. Strömberg J, Ibsen-Sörensen A, Fridén J. Comparison of Treatment Outcome After Collagenase and Needle Fasciotomy for Dupuytren Contracture: A Randomized, Single-Blinded, Clinical Trial With a 1-Year Follow-Up. J Hand Surg Am. 2016;41(9):873-880. doi: 10.1016/j.jhsa.2016.06.014. Epub 2016 Jul 27.
28. Denkler K. Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature. Eplasty. 2010;10:e15.
CITATION
DOI: 10.17511/ijoso.2019.i04.02
Published: 2019-10-23
How to Cite
Kripal Soni, R., & Kumar Malviya, V. (2019). Needle aponeurotomy for dupuytren’s contracture of hand with extended physical therapy and serial intralesional steroid injections. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 5(4), 239-245. https://doi.org/10.17511/ijoso.2019.i04.02
Section
Original Article
OAI - Open Archives Initiative
Therapoid
