Update on Dupuytren Disease: Pathogenesis, Natural History, Treatment, and Outcomes

Pdf Summary

Dupuytren disease (DD) is a chronic, fibroproliferative disorder affecting the palmar fascia, leading to debilitating digital contractures. Despite attempts to understand its pathogenesis and molecular biology, the root causes of DD remain unclear, and current treatments focus on relieving contractures. Treatment options range widely, including percutaneous needle fasciotomy (PNF), collagenase injections, and surgical interventions, with varying degrees of risk, recovery times, and success rates.<br /><br />DD often progresses slowly over several years, but unpredictability in its development and progression challenges treatment selection. Although DD was traditionally linked to Northern European ancestry, genetic factors are now understood to have a more significant role, showing patterns suggestive of autosomal dominance with variable penetrance. Prevalence varies globally, with the highest rates in Africa and Asia.<br /><br />Surgical treatment involves removing diseased fascia and can include various techniques like fasciectomy and dermatofasciectomy, with complications such as nerve injury and recurrence risks. PNF is a cost-effective, minimally invasive option that can be performed in an office setting but has a higher recurrence rate than surgery. Collagenase injections initially appeared promising but present issues with durability and cost.<br /><br />Alternative methods, such as dynamic external stretching and combined treatment strategies, may aid in complex cases. Postoperative therapy focuses on managing edema, improving motion, and wearing extensions orthoses for contracture prevention. Understanding the different facets of DD, including genetic predisposition, progression unpredictability, and treatment outcomes, allows for more personalized and effective approaches to patient care. Despite numerous medical advances, the ultimate solution remains elusive, underscoring the need for ongoing molecular and genetic research.

Keywords

Dupuytren disease

fibroproliferative disorder

digital contractures

treatment options

genetic factors

autosomal dominance

surgical intervention

percutaneous needle fasciotomy

collagenase injections

postoperative therapy