Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture

Abstract

PurposeTo describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. MethodsThis prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60 degrees or more from Dupuytren contracture were included. Outcomes measures were range of motion, sensibility, scar pliability, self-reported outcomes on expectations, recovery, and satisfaction with hand function, Disabilities of the Arm, Shoulder, and Hand scores, safety and social issues of hand function, physical activity habits, and quality of life with the Euroqol. ResultsThe extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months 32% considered hand function as fully recovered, and 73%were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder and Hand score and the Euroqol improved over time. 2 ConclusionAfter surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability

“…A recent prospective study of 90 patients treated with limited fasciectomy at a university hand surgery centre in Sweden, reported that at 1 year the mean AED for the MCP joints was 5 (SD 9) and for the PIP joints 22 (SD 18). 11 It is unclear whether the authors used 0°for hyperextension (as in our study) or used the actual values, which would underestimate the reported extension deficit. They reported that 81% were satisfied at 1 year.…”

An overview on therapeutic potential and various applications of microbial collagenases

“…However, considerable attention has been paid for the non-operative treatment of Dupuytren disease. Injectible collagenase is more efficient than surgical fasciotomy and has milder side effects, which leads to higher patient satisfaction [97,98]. Studies on the influence of CHCs on Dupuytren's cords and on Dupuytren's disease fibroblasts have demonstrated that clostridial collagenases can efficiently digest ECM of Dupuytren's disease cords without inducing significant cytotoxicity or structural damage to non-collagenous tissue elements [99,100].…”

Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease

“…(19) The patients were invited to the study in the order they were scheduled for surgery thus forming a consecutive sample. Inclusion criteria for the cohort study were having DD in one or several fingers of digit II-V, with an extension deficit of 60° or more in an isolated finger joint (metacarpophalangeal (MCP) or proximal/distal interphalangeal (PIP and DIP) joint only) or throughout a whole finger (MCP, PIP, DIP together).…”

“…(16) Furthermore, DD leads to consequences such as activity limitations, safety and social issues of hand function and quality of life issues. (1,17,18,19) Higher DASH score has also shown to correlate with worse general health (20), but the association between DASH and quality of life outcomes after fasciectomy for DD has not been investigated previously.…”