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At least 1,495 records · Page 83Linked to original sources
PubMed1979

Palmar fibromatosis-"Dupuytren's contracture". A comparison of light electron and immunofluorescence microscopic findings.

A comparison of light, immunofluorescence and electron microscopic findings in palmar fibromatosis (Dupuytren's disease) revealed that the three morphologic phase of Luck; I. proliferative, 2. involutional, and 3. residual, corresponded for the most part to I. fibroblastic, 2. myofibroblastic or 3. fibrocytic lesions, respectively. The spectrum between proliferative phase and residual phase appeared immunohistochemically as a decrease in collagen type III, and an increase of collagen type I. Myosin was found in substantial quantities only during the involutional phase, distinguished by myofibroblasts, presumably with contractile capabilities. Thus, the clinical presence of contractures with palmar fibromatosis might also be explained in the absence of distinct fiber formation.

Collagen↗
PubMed2001

Radiotherapy optimization in early-stage Dupuytren's contracture: first results of a randomized clinical study.

PURPOSE: Radiotherapy (RT) can prevent progression of Dupuytren's contracture (DC). It is unknown whether there is a dose response and which dose is sufficient. Herein, the 1-year results of a prospective randomized trial are presented which compared two different RT dose concepts with each other. METHODS: 129 patients (67 males; 62 females) were entered in this study: 69 had bilateral and 60 uni-lateral involvement of DC accounting for 198 irradiated hands. According to Tubiana's classification, 73 hands had Stage N (nodules/cords, no extension deficit = flexion deformity), 61 had Stage N/I (< or = 10 degrees deficit), 59 had Stage I (11-45 degrees deficit), and 5 had Stage II (46-90 degrees deficit) DC. Prophylactic RT was randomly delivered; in Group A, 63 patients (95 hands) received 10 x 3 Gy (total dose, 30 Gy) in 2 series (5 x 3Gy) separated by 8 weeks; in Group B, 66 patients (103 hands) received 7 x 3 Gy (total dose, 21 Gy) in 1 series within 2 weeks. Orthovoltage RT (120 kV) was applied using standard cones and individual shielding of uninvolved areas of the palm. Relevant patient and disease parameters were equally distributed in both groups. Evaluation (toxicity, efficacy) was performed at 3 and 12 months after RT. Subjective (patient's opinion) and objective parameters (palpation, measurements, and comparative photographs) were applied to assess treatment response. Minimum follow-up (FU) was 1 year. RESULTS: Acute toxicity was minimal, but slightly more pronounced in Group B. Seventy-six (38%) hands developed skin reactions CTC 1 degrees (A, 30; B, 46); and 12 (6%) had skin reactions CTC 2 degrees (A, 4; B, 8). Chronic side effects were limited to dryness, desquamation, skin atrophy, and change of sensation (LENT 1 degrees ) in 9 (5%) sites without differences between the two groups. At 3 and 12 months after RT, subjective and objective reduction of symptoms, nodules, and cords occurred in both groups (p < 0.01) with no differences between the groups: in Group A, 55 (56%) sites regressed, 35 (37%) remained stable, and 7 (7%) progressed, whereas in Group B, 55 (53%) regressed, 39 (38%) remained stable, and 9 (9%) progressed at 12 months FU (NS). Overall and mean number of nodules, cords, and skin changes decreased at 3 and 12 months. The "treatment failure" rate at 1 year was 16 of 198 (8%), but only 4 (2%) sites required hand surgery for disease progression. Seven of 60 patients with unilateral DC received prophylactic RT for the initially uninvolved, contralateral hand due to progression of DC. CONCLUSION: Both prophylactic RT concepts have been well accepted and tolerated by patients. Within the first year, they were equally effective to prevent further disease progression of DC and obtain considerable symptomatic improvement. Although 1-year results suggest similar response rates for both treatment groups, long-term FU of > 5 years has to be awaited for final assessment and recommendation of an optimized RT treatment schedule.

Adult↗
PubMed1992

Severe contractures of the proximal interphalangeal joint in Dupuytren's disease: results of a prospective trial of operative correction and dynamic extension splinting.

In a prospective study, 23 proximal interphalangeal joints that were severely contracted (> or = 45 degrees) as a result of Dupuytren's disease underwent operative correction and 6 months of dynamic extension splinting. Proximal interphalangeal joint extension was measured preoperatively and postoperatively at 3-month intervals for 1 year and at 6-month intervals thereafter. Mean follow-up was 2 years (minimum, 1 year). Overall, at 2 years, 44% improvement in proximal interphalangeal joint extension was noted. Mean improvement of 59% in proximal interphalangeal joint extension was noted in patients who complied with the postoperative dynamic extension splinting program. Patients who were noncomplaint demonstrated a 25% improvement in proximal interphalangeal joint extension. The difference in values between patients who were compliant and those who were not was statistically significant. Other factors--severity of contracture, digit involved, and the necessity for capsular release--were not significantly related to outcome. This study suggests that soft tissue responds to continuous dynamic extension stresses and can be remodeled over time.

Adult↗
PubMed1978

Pathogenesis of Dupuytren's contracture: a correlative clinical-pathological study.

The tissue from 38 patients with Dupuytren's contracture was submitted for light and electron microscopy. The clinical and pathological data were correlated so that three stages of disease were recognized: early, active, and advanced. The cell of early disease was the perivascular fibroblast; whereas, the cell of active disease was the myofibroblast. Because the myofibroblasts have cell-to-cell and cell-to-stroma attachments, the collagen not only becomes oriented as it is formed, but it also is subjected to a contractile force.

Adult↗
PubMed1982

Dorsal pedicle flap for resurfacing a moderate thumb-index web contracture release.

If a dorsal rotational flap is chosen for reconstructive resurfacing of a moderate thumb-index flexion-adduction web contracture release, the design advised in this paper is advocated as the most physiologic use of skin with least torsion on the pedicle base. The key to the procedure is designing the pedicle to cross the axis of motion of the pedicle tip on one side, preferably the thumb, and the pedicle base on the opposite side.

Adult↗
PubMed1983

Factitious extension contracture of the elbow: case report.

A case report of factitious extension contracture of the elbow due to injection-induced fibrous myopathy of the triceps is presented. Crystalline material was demonstrated in muscle biopsies preserved in absolute alcohol and surgical section of the triceps resulted in correction of the deformity. A review of the literature and differentiation between Weber-Christian systemic panniculitis and factitial panniculitis is discussed.

Arm↗
PubMed1984

Double V-Y flap for correction of proximal interphalangeal joint flexion contractures.

A double V-Y flap made up of skin available at the site is an alternative to grafts or cross-finger flaps for release of proximal interphalangeal joint contractures. After the initial incision, the technique involves loosening of the contracted skin so that perpendicular nutrient microvessels are preserved. Suggested postoperative management includes subcutaneous dorsal Kirschner wires to maintain extension without jeopardizing the vascular supply of the flap and gentle stretching of the skin as soon as the wires are removed. Three cases are presented to illustrate the variety of applications of double V-Y technique.

Adult↗
PubMed1984

Microvascular changes in Dupuytren's contracture.

Previous studies of certain fibrotic lesions (hypertrophic scar, keloid, pseudotendon) have revealed pervasive microvascular occlusion. Lowered oxygen tension is considered to be a stimulus to excessive collagen production and, hence, the scar. Because its characteristics are similar to those of other lesions, Dupuytren's contracture appeared to be a good model in which to confirm the presence of occluded microvessels. Six cases were examined by light, electron, and polarizing microscopy. Most of the microvessels from the precontracture band area throughout the periphery of the body of the nodules were occluded by a bulging of the endothelial cells into the lumen. The microvessels were surrounded by extensive layers of basal laminae. The nodules were essentially avascular. The presence of another fibrotic lesion in which pervasive microvascular occlusion occurs is suggestive of an underlying biologic principle concerning the generation of all fibrotic lesions.

Basement Membrane↗
PubMed1987

Stenosing tenosynovitis in Dupuytren's contracture.

Patients with symptoms of stenosing tenosynovitis and clinical evidence of overlying Dupuytren's contracture were treated with localized total fasciectomy through multiple Y-V plasties and the excision of the A1 pulley of the affected digit. At operation the stenosing tenosynovitis could be separated into two categories--patients with external compression from contracting vertical septa or patients in whom the tendon constriction appeared unrelated to the overlying fascial disease.

Dupuytren Contracture↗
PubMed1987

Isolated contracture of the abductor digiti minimi.

A case of isolated contracture of an intrinsic hand muscle, the abductor digiti minimi, after the use of an upper extremity tourniquet is reported. Six cadaver specimens were studied after latex arterial injection. We present an anatomic study and pathomechanical analysis, along with a review of the literature on tourniquet-associated injuries.

Contracture↗
PubMedDate not supplied

Recognition and treatment of refractory posterior capsular contracture of the shoulder.

SUMMARY: Limitation of internal rotation has been reported in conjunction with impingement syndrome of the shoulder. A group of 9 patients was identified who had discrete, painful loss of internal rotation associated with refractory impingement syndrome. The duration of symptoms averaged 18 months (range, 11 to 33 months), and all patients failed a course of physical therapy specifically addressing loss of internal rotation. Six patients reported traction as the mechanism of injury, and 3 developed motion loss and pain following a posterior capsular shift procedure. All patients underwent arthroscopy, and were observed to have a thickened posterior capsule. An arthroscopic release of the posterior capsule improved motion in all patients, with substantial relief of pain. At an average of 19 months follow-up (range, 11 to 35 months), internal rotation in 90 degrees of abduction improved from 10 degrees preoperatively to 47 degrees postoperatively, and there were no complications related to the procedure. We conclude that chronic loss of internal rotation secondary to posterior capsular contracture may be an explanation for refractory pain in some patients with an initial diagnosis of impingement syndrome. This condition appears to be amenable to arthroscopic posterior capsular release.

Adult↗
PubMed1999

Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture.

Arthroscopic debridement and capsular release was performed in a 57-year-old woman because of post-traumatic stiffness in the dominant right elbow joint. During this procedure, the median and radial nerves were completely transected. A few recent reports of small series have described encouraging results after arthroscopic capsular release of post-traumatic elbow contracture, but the present case demonstrates the inherent risk of damage to neurovascular structures.

Accidental Falls↗
PubMed1990

Cell-controlling factors in Dupuytren's contracture.

The search for the causative factors in Dupuytren's disease has historically progressed form gross anatomical dissection, through microscopical tissue studies, to the biochemistry of the collagen produced. But these elements are merely the end products of cellular activity - not revealing the factors responsible for the changes in cellular activity. Recent biochemical investigations suggest that a number of conditions including localized microvascular ischemia and high alcohol concentrations transform the "benign" xanthine dehydrogenase of endothelial cells to the oxygen-free radical-releasing xanthine oxidase. Oxygen-free radicals are highly reactive species with half-lives in the order of milliseconds capable of both damaging the surrounding peri-microvasculature and stimulating fibroblast proliferation. It is this stimulation of fibroblast proliferation in the palmar fascia that is the key event in the pathogenesis of Dupuytren's contracture.

Dupuytren Contracture↗
PubMed1990

Dupuytren's contracture with associated changes in the plantar aponeuroses and in the auricular conchae.

The author reports a forty year old man presenting with Dupuytren's contracture affecting both hands, feet and auricular conchae. The patient is epileptic having been treated for twenty eight years with phenobarbitone and phenytoin. He had histologically proven Dupuytren's disease on both hands, but unfortunately no material was available from the ears. The follow up to date suggests that the auricular lesions have progressed slowly.

Adult↗
PubMedDate not supplied

Releases of subscapularis contracture: an anatomic and clinical study.

Correction of anterior subscapularis contracture is an important step in soft-tissue balancing at the time of total shoulder replacement (TSR). An anatomic and clinical investigation was undertaken to investigate the effect of steps involved in subscapularis release. In 14 cadaveric shoulders studied, the subscapularis insertion consisted of three regions: a thick superior tubular tendon (STT), a flat middle tendon, and an inferior portion where the muscle fibers insert directly into the humerus. In 16 consecutive patients undergoing primary TSR for osteoarthritis, measurements of subscapularis length were taken after different releases. An average of 0.9 cm (confidence interval, 0.7-1.1 cm) of excursion was added after anterior capsular release, and an additional 0.7 cm (confidence interval, 0.5-0.9 cm) of excursion was obtained after STT release. Incision of the STT is an alternative means of gaining subscapularis length when balancing the soft tissues in patients with osteoarthritis undergoing TSR.

Arthroplasty, Replacement↗
PubMed1995

Intraoperatively fabricated bite block in the management of scar contracture hypomobility.

Intraoral surgical procedures produce scar tissue formation that may limit mandibular opening. Many procedures have been developed to release these scar contractures, but most lead to further scar formation and greater limitation in opening. The purpose of this article to describe a technique with the use of an intraoperatively fabricated self-curing acrylic bite block combined with aggressive physical therapy in the management of this difficult clinical problem.

Adult↗