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Dupuytren's Disease

 
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PostPosted: Thu Oct 13, 2005 2:18 pm GMT +0000    Post subject: Dupuytren's Disease Reply with quote

Howdy. Do you know anything about Dupuytren's (most Dr's don't)? More specifically, how it relates to, and affects/ is affected by mountain biking? I was recently diagnosed with it, and have 2 nodules; one in each hand, no contracture yet. It also appears that I may have Ledderhose as well. My concern, beside the pain, is that it may be aggrivated by the vibration from riding (after reading some studies, though not bike related). Also, do you have any suggestions for a good glove and/ or grip? How about shoe insoles?
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The Bike Doc
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PostPosted: Fri Oct 14, 2005 6:09 am GMT +0000    Post subject: Reply with quote

Gotdurt:

Dupuytren's disease or contractures are nodular thickening of the tendons of the 4 and sometimes 5th finger of the hands, usually affecting both sides. It may be passed on by an inherited trait, triggered by diabetes or excess consumption of alcohol. Though it was formerly felt to be due to repetitive use trauma, that causes is now being discounted as the contracture often markedly worsens in laborers who retire from their manual work with the hands or when forced immobility occurs from an unrelated hand or arm injury. It tends to be more severe when it develops in the younger adult years. Physical findings include a palpable nodule on the palm side of the hand over the 4th finger base around the palmer crease. Treatment options include occupational therapy to maximize hand/finger mobility, local injection with steroids, radiation therapy, and surgical therapy to name a few of the available options, all with varying degrees of success. You should seek consultation with a hand surgeon. Your doctor should also evaluate you for diabetes and if you drink more than two alcoholic beverages a day (two 12 oz beers, two 1 oz of shots of hard liquor, two 6 oz glasses of wine or any combination of two of these) you should also speak with your doctor about your stopping drinking alcohol. Do not limit your physical activity or use of your hand at this time.

Leddenhose disease can often acompany Dupuytren's disease. It is basically a similar involvement of the feet. This complication is not as well know among English speaking physicians as most of the references about it are in French, German and Italian.

I have included two references with their abstracts below.


Foot and Ankle Surgery
Volume 3 Issue 3 Page 121
doi:10.1046/j.1460-9584.1997.00056.x

Plantar fibromatosis (Morbus Ledderhose): an atypical case with cystic tumours
J BENTHIEN, R FUHRMANN & R VENBROCKS
Tumours on the sole of the feet most commonly result from plantar fibromatosis (also known as Ledderhose's disease or nodular plantar fasciitis). Such tumours may be difficult to diagnose and to treat. Other malignant and benign fibrous tissue tumours cannot always be ruled out by their clinical appearance alone. If the precise nature of a tumour on the sole of the foot cannot be ascertained clinically, biopsy and excision should be performed. This paper is a case report of a patient who presented with two cystic tumours on both feet that could not be classified as Ledderhose's disease by clinical and radiological examination alone. Due to its unusual clinical presentation the tumour on the right foot, which was larger than the tumour at the contralateral side, was excised for histological evaluation. Intraoperatively, the partly cystic tumour was confirmed to have its origin in the plantar fascia and it resembled nodular fasciitis without signs of malignant transformation. Histology confirmed the diagnosis of plantar nodular fasciitis. In this paper, diagnosis and management of Ledderhose's disease are discussed, with particular reference to atypical cases of the disorder.


Postgrad Med J. 2005 Jul;81(957):425-8.

Clinical associations of Dupuytren's disease.

Hart MG, Hooper G.

College of Medicine, Teviot Place, Edinburgh EH8 9AG, UK. m.g.hart@sms.ed.ac.uk

Dupuytren's disease (DD) is a common progressive fibrotic condition affecting the palmar and digital fascia. Although its management is undertaken by hand surgeons, it is commonly seen by other doctors as an incidental finding. In many cases it is believed to be associated with other medical conditions, although the evidence for such associations is not always clear. This review considers the evidence behind these associations and discusses the aetiology of DD. By doing so, it is hoped that this review will permit a better understanding of the relevance of DD as a clinical sign.

I hope this information helps.

Thanks,
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Paul K. Nolan, MD
AKA: The Bike Doc
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