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FAQ - Dupuytren's Contracture
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What is Dupuytren's Disease and what can be done about it?


Dupuytren's disease is an abnormal thickening of tissue beneath the skin in the palm of the hand. The disease often develops in both hands, and it occasionally occurs in the soles of the feet. Dupuytren's disease, which is also called Viking's disease, usually progresses very slowly and may never require treatment. In many cases the disease does not extend to the fingers but remains confined to the palm area. When the tissue between the skin and tendons (fascia) thickens, it may eventually limit movement or cause the fingers to bend so that they cannot be straightened.

Dupuytren's disease occurs most often in people age 50 and older. While treatments are available, there is no permanent cure for Dupuytren's disease. (1)

Pat O'Connor
Lymphedema People
http://www.lymphedemapeople.com  (+ info)

Capsular contracture after a breast augmentation?


Just wondering if anyone else has experienced this. I had asymetrical breast and had an implant put in my left breast to correct the problem. I had my augmentation done in May of 2003 and had a second surgery in March of 2004 to correct the "CC". I believe I have it again.

I was just wondering if anyone else has had "CC" after augmentation and what you did for it? How many times did you have it?
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sorry, i never got it, but i feel for you. I am sorry that you are having this re-occuring problem. I believe you should contact your surgeon and have him check it out. As you know, this is nothing to play with. Good luck!  (+ info)

where can dupuytren's disease be treated in georgia?


surgery for a 14 year old how much would it cost?
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Look for a medical group that specializes in plastic and reconstructive surgery. It might be a helpful to contact your primary care doc to set up a referral to the proper doc. Otherwise, the yellow pages list doctors by specialty. Usually surgeons provide a free evaluation to determine whats needed and to estimate costs. This can be very expensive surgery because it usually requires several surgical procedures on each hand, so its like having a half-dozen operations at once and this type of surgery can involve several types of specialties, so it sometimes requires a team of surgeons.  (+ info)

Dupuyten's contracture or other hand tendon problem/injury?


To treat it did you:

Have hand surgery?
Used Chinese medicines?
Change lifestyle, ie: drinking, diet?

I have quickly advancing symptoms and don't know anything about it.
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Sorry but surgery is the only permanent answer for this condition. Don't waste your money or recovery time on the other alternatives.
Good luck!  (+ info)

Has radiation proven effective for Dupuytren's Disease?


A number of nonsurgical options have been proposed for Dupuytren's contracture, including medications and radiation therapy to the hand. Unfortunately none has proved helpful. Cortisone injections may ease the pain of a tender nodule, but usually doesn't affect the progression of Dupuytren's contracture.

Researchers are currently investigating enzyme injections for Dupuytren's contracture. Promising results have shown that enzymes injected under the skin can break down the knots and cords of tissue. Ongoing clinical trials will show whether this can prevent Dupuytren's contracture from recurring. Until then, enzyme injection is considered experimental and is only available at a few medical research facilities.

Here's a link to any clinical trials being done concerning Dupuytren's Disease:

http://www.centerwatch.com/patient/studies/cat255.html

_________________

In addition, I found perinent info on a site, Depuytren's Learning Channel, that details a few more exploratory non-surgical treatments that show favorable results:

Collagenase Enzyme

The most promising therapeutic agent on the horizon for the treatment of Dupuytren’s contracture is intralesionally injectase collagenase enzyme.

The clinical use of collagenase enzyme in the treatment of collagen disorders has been studied since the 1940s. In the 1970s, the myofibroblast was determined to be important to the pathogenesis of Dupuytren’s disease, confirmed by studies that showed the contraction of the collagenous palmar fascia and overlying skin and fingers was directly related to the contractile abilities of myofibroblasts. In the 1980s, immature type III collagen was found to proportionately increase in relation to normally occurring type I collagen within affected palmar fascia. This led investigators to target collagen as a way of treating the cords seen in Dupuytren’s contracture.

The use of clostridial collagenase enzyme as a nonsurgical treatment for Dupuytren’s contracture has most recently undergone further investigation under the Food and Drug Administration (FDA) guidelines.

In February 2007, at the American Academy of Orthopaedic Surgeons meeting, results of a randomized double-blind, placebo-controlled study were presented by Lawrence C. Hurst, MD, and Marie Badalamente, PhD. Thirty-five adults, with a mean age of 63 years and a flexion deformity of ≥ 20 degrees of the MP and/or PIP joints were enrolled. Patients could receive a maximum of 3 injections in the primary joint at 4- to 6-week intervals. Flexion contracture, range of motion, grip strength, and adverse events were documented at follow-up visits at 1 day, 1 and 2 weeks, and 1 month.

Primary joint contractures affected the MP in 21 patients and the PIP in 14 patients. Twelve patients received placebo, and 23 patients received collagenase enzyme injections. Results showed that 21 of 23 collagenase-treated patients (91%) and 0 of 12 placebo-treated patients achieved joint correction. No loss of grip strength or normal range of finger motion was seen in any patient. The mean time to success in the collagenase-treated joints was 8 days.

Of 35 patients who completed this study, 19 were entered into an open-label study for treatment failure or to treat other joint contractures. In the open-label study, 14 of 16 MP joints (88%) and 13 of 19 PIP joints (68%) were fully corrected, with an average of 1.5 injections and 1 to 29 days required for clinical success. Adverse event type and frequency were similar to these in the controlled study and included pain at the injection site, hand edema, and ecchymosis; all of these events resolved well.

Repeated collagenase enzyme injections did not induce an allergic reaction, confirmed by immunoglobulin E titers.

Injection of clostridial collagenase for the treatment of Dupuytren’s contracture shows promise as a viable alternative to surgery.

Matrix Metalloproteinase (MMP) Inhibition

The role of MMPs in the development of fibroproliferative diseases has been studied in an effort to gain a better understanding of the complexities of tissue maintenance and wound repair. MMPs have previously been analyzed in samples of patients with Dupuytren’s disease that have undergone the continuous elongation techniques of Messina and Messina. Further studies by Ulrich et al have indicated a disturbed physiologic balance between MMPs and their endogenous antagonists. This may lead to the pathway to the pathogenesis of Dupuytren’s disease (Ulrich 2003) and ultimately, more direct targeted therapies. Johnston et al analyzed the MMP and inhibitors of MMP gene expression from surgical specimens of patients with Dupuytren’s disease. From this analysis, theories of contraction and fibrosis have been put forth with the goal that knowledge of the complete expression profile will provide therapeutics targeting these genes.

The role of an MMP inhibitor was explored by Townley at the 2006 American Society for Surgery of the Hand (ASSH) meeting. Based on the premise that MMPs are proteolytic enzymes that play an integral role in the regulation of mechanical tension in progressive Dupuytren’s contracture, the broad-spectrum MMP inhibitor, ilomastat, was evaluated for its in vitro effectiveness on matrix contraction by Dupuytren’s fibroblasts. Ilomastat was shown to have suppressed the activity of MMP-1 and MMP-2, suggesting that MMP activity may be a therapeutic target in fibrotic conditions.

Triamcinolone Acetonide Steroid

Injections of triamcinolone acetonide steroid can be used in the early stages of Dupuytren’s disease for the treatment of nodules and may slow the progression of contracture. The nodules of Dupuytren’s disease contain a high concentration of collagen with an increased ratio of type III to type I, similar to the findings in hypertrophic scars. In a study by Ketchum and Donahue (2000) after 3.2 steroid injections per nodule, the disease regressed in 97% of hands. The nodules became softer and smoother. However, 50% of patients experienced disease reactivation 1 to 3 years after the last injection in the nodules that were previously injected.

Radiotherapy

Radiotherapy has been used to prevent disease progression in the early stages of Dupuytren’s contracture. However, both acute toxicity and chronic side effects were observed, such as redness or dryness of the skin, extensive erythema, moist desquamation, swelling, and an alteration in heat and pain sensation. Among hand surgeons, prophylactic radiotherapy is not supported; surgery performed after radiotherapy is unduly complicated.

Fluorouracil (5-FU)

5-FU has been used to treat fibroproliferative disorders of the eye and skin by a mechanism that inhibits thymidylate synthetase blocking DNA replication. It has been shown to be a fibroblast antiproliferative agent. The alteration of collagen synthesis that occurs in Dupuytren’s contracture is through increased deposition of collagen types I and III. Myofibroblasts seen in Dupuytren’s tissue are believed to be the active cells that generate the pathologic tissue contraction. Currently, a prospective clinical trial is investigating the intraoperative use of 5-FU in the treatment of Dupuytren’s contracture. Despite positive in vitro results, 5-FU showed no significant difference in clinical trials in which digits were treated.

Gamma Interferon

In a very small study, Pittett et al investigated the use of intralesional injection of gamma interferon, a cytokine produced by T-helper lymphocytes, in the treatment of hypertrophic scars and Dupuytren’s disease. Gamma interferon decreased the size and symptoms of Dupuytren’s lesions, possibly by decreasing the expression of alpha smooth muscle actin and the production of collagen.

http://www.dupuytrenschannel.com/index.php?option=com_content&task=blogcategory&id=19&Itemid=38

Hope this info helps answer your question. Good luck!  (+ info)

does anyone know anything about dupertren contracture of the hands?


relatively common diorder with cordlike or nodular thickening of both hands with fourth and fifth fingers mostly affected. the cause is unknown but has a genetic predisposition.  (+ info)

how can i correct my hip contracture? i am an above knee amputee and havent been stretching my limb.?


not wearing prothesis right now due to weight gain. need to get on the program. just thought i would see how to reduce the effect of not stretching my limb. help
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Your second line of your question says it all. You state that you haven't been stretching. Of course you are going to start to lose flexibility. You must stretch. I will assume that you have been to a Physical Therapist before. If not you should have been. You need to follow the program of stretching and strengthening that should have been given to you to prevent such problems as these. You need to be spending some time on your stomach to stretch out the front of your hip (flexors). I would recommend that you go back to your doctor and ask for a referral to a Physical Therapist and possibly a dietitian as well. You need to make sure that you are staying as active as possible and eating right.  (+ info)

What causes nighttime leg cramps that result in extremly painful temporary contractures called?


Occasionally, I wake up in such a severe state of leg/calf pain when these episodes of contractures occur. It takes all I can do to force the contracture to ease. I usually end up trying to force my foot back to a normal posiiton to stop the contracture. And the pain is beyond anything else I can endure. I am also Type II Diabetic. Please help.
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These cramps (Charlie horses) are commonly caused by dehydration, too much caffeine or too much booze as well as by a deficiency of potassium (bananas), calcium (dairy products), magnesium (nuts) or vitamin B6 (dairy products).  (+ info)

What causes Dupuytren's disease.?


i dont want to know what it is like oh its the construcking of tissue no i want to know what causes it!
like holding cheese in your hand causes it for example
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There is no clear answer yet but it is linked to trauma, liver damage, alcoholism, and diabetes. The disease can be gained by heredity  (+ info)

what's the best treatment for a muscle contracture?


the muscle is the soleus
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when the muscle contracts (spasm) the best thing to do is to stretch it, massage it or friction it. To stretch the soleus bend the have your leg straight while sitting on the floor or bed, put a towel on the bottom of the foot (the ball of the foot) bend the knee a little and pull back.
heres a site where it can show you how to do it while standing too.
Good luck ^i^
sMT  (+ info)

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