Steroid Injection and Needle Aponeurotomy for Dupuytren Contracture: A Randomized, Controlled Study

McMillan, Catherine; Binhammer, Paul

doi:10.1016/j.jhsa.2012.04.026

Cited by 47 publications

(17 citation statements)

References 32 publications

(24 reference statements)

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“…Lack of understanding of the signaling pathways driving disease pathogenesis has meant that there is no specific therapeutic for treating early disease or for preventing recurrence following excision or division of the cord. The absence of valid targets has led to empirical treatment with modalities such as local steroid injection (16,17) or radiotherapy (26,27).…”

Section: Discussionmentioning

confidence: 99%

“…Histological studies have identified the presence of immune cells in Dupuytren's disease; in particular, the number of macrophages was shown to correlate with the quantity of myofibroblasts (15). Intralesional steroid injections led to temporary softening and flattening of Dupuytren's nodules (16) and reduced recurrence following percutaneous needle fasciotomy (17). It has been suggested that this therapeutic benefit of steroids in early Dupuytren's disease may be due to diminished leukocyte recruitment (18), as well as increased apoptosis of macrophages and fibroblasts, with reduced proliferation of the latter (19).…”

Section: Significancementioning

confidence: 99%

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Unraveling the signaling pathways promoting fibrosis in Dupuytren's disease reveals TNF as a therapeutic target

Verjee

Verhoekx

Chan

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

111

130

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Significance Fibrosis, a hallmark of many clinical disorders, occurs because of uncontrolled myofibroblast activity. We studied Dupuytren's disease, a common hereditable fibrotic condition that causes the fingers to irreversibly curl toward the palm. We found that freshly isolated tissue from Dupuytren's patients contained macrophages and released proinflammatory protein mediators (cytokines). Of the cytokines, only TNF selectively converted normal fibroblasts from the palm of patients with Dupuytren's disease into myofibroblasts via activation of the Wnt signaling pathway. Conversely, blockade of TNF resulted in reversal of the myofibroblast phenotype. Therefore, TNF inhibition may prevent progression or recurrence of Dupuytren's disease.

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Section: Discussionmentioning

confidence: 99%

Section: Significancementioning

confidence: 99%

Unraveling the signaling pathways promoting fibrosis in Dupuytren's disease reveals TNF as a therapeutic target

Verjee

Verhoekx

Chan

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

111

130

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“…Functional outcomes reported by intervention; Collagenase injection, needle fasciotomy and surgery [3,6,7,15,16,20,22]–[30,33,35]–[45,47,48,50]–[109]. …”

Section: Supplementary Materialsmentioning

confidence: 99%

Optimal functional outcome measures for assessing treatment for Dupuytren’s disease: a systematic review and recommendations for future practice

Ball

Pratt

Nanchahal

2013

BMC Musculoskelet Disord

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BackgroundDupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment.MethodsA literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures.ResultsNinety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years.ConclusionsThere is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes.

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“…A recent randomized controlled trial (n = 47), however, found significant differences in favor of steroid injection as an add-on to a percutaneous needle aponeurotomy, suggesting there may nonetheless be a role for corticosteroids in the treatment of Dupuytren contracture. 15 More research on this topic is definitely requested before firm conclusions can be drawn.…”

Section: Discussionmentioning

confidence: 99%

Dupuytren Disease

Huisstede¹,

Hoogvliet²,

Coert

et al. 2013

Plastic and Reconstructive Surgery

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Steroid Injection and Needle Aponeurotomy for Dupuytren Contracture: A Randomized, Controlled Study

Cited by 47 publications

References 32 publications

Unraveling the signaling pathways promoting fibrosis in Dupuytren's disease reveals TNF as a therapeutic target

Unraveling the signaling pathways promoting fibrosis in Dupuytren's disease reveals TNF as a therapeutic target

Optimal functional outcome measures for assessing treatment for Dupuytren’s disease: a systematic review and recommendations for future practice

Dupuytren Disease

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