DUPUYTREN'S DISEASE

Introduction

Dupuytren’s disease (DD) is a benign, generally painless fibroproliferative disorder of the palmar and digital fascia, whereby a thick collagen cord develops, causing flexion deformity -- Dupuytren's contracture (DC) -- of the affected metacarpophalangeal (MP) or proximal interphalangeal (PIP) joints. The pathogenesis of DD is largely genetic, and the complexities of its underlying cellular and subcellular mechanisms are only starting to be understood. Surgery has been the mainstay of treatment for centuries; however, less invasive approaches have been shown to be effective in more recent clinical trials and in clinical practice.

Related anatomy

Normal anatomy
- Palmar fascia: triangular-shaped structure composed of broad sheets or narrow bands of fibers oriented longitudinally and transversely
- Pretendinous Bands: longitudinal fiber bands running superficial to the flexor tendons from the level of the superficial arch to the MP joint area distally
- Natatory ligament: oriented transversely and lies just beneath the skin at each commissure; sends fibers distally along the lateral border of each digit to merge with the lateral digital sheet (LDS)
- Lateral Digital Sheet (LDS): Formed by merging fibers of the spiral band and natatory ligament; runs lateral to and along side the neurovascular bundle (NVB)
- Grayson ligament: Palmar to the NVB, passing from the flexor sheath to the skin; in DC, it can become part of a lateral cord when it joins the diseased lateral digital sheath (LDS)
- Cleland ligament: Dorsal to the NVB and arises from the phalanges; relatively uninvolved in DC
Diseased fascia (collagen cords)
- Nodules usually appear before contractile cords
- Central cord: involvement of the pretendinous bands; usually results in metacarpophalangeal joint contracture
- Spiral cord: involvement of pretendinous band, spiral band, LDS, Grayson ligament; generally results in PIP joint contracture
- Natatory cord: develops from the distal fibers of the natatory ligament, resulting in a web-space contracture
- Retrovascular cord: dorsal to NVB; usual cause of a distal interphalangeal (DIP) joint contracture
- Transverse Ligament of Palmar Aponeurosis (TLPA): superficial intermetacarpal ligaments or Skoog's ligament is an important part of the palmar aponeurosis. Radially, the TLPA forms the proximal commissural ligaments. The deep surface of the TLPA attaches to the septa of Legueu and Juvara. This septa forms confluence with the palmar plate, inter-palmar plate ligament, sagittal band and A1 pulley.

Relevant basic science

Luck's Three phases of Dupuytren's Disease

proliferative (random proliferation of myofibroblasts)
involutional (myofibroblasts align along tension lines in the palm)
residual (acellular disease with collagen-laden tissue)

Normal palmar tissue

type I collagen
fibroblasts

Dupuytren’s disease (DD)

Type III collagen predominates
Myofibroblasts containing bundles of actin microfilaments, conferring contractile properties that fibroblasts do not have.
Increasing levels of mechanical tension have also been shown to influence fibroblast differentiation into myofibroblasts.
Adjacent myofibroblasts connect to each other and to collagen via fibronectin.
Transforming growth factor-beta 1 (TGF-β1), TGF- β2, epidermal growth factor, platelet-derived growth factor and connective tissue growth factor (PDGF) have been suggested to play a role in initiating abnormal cellular proliferation. These growth factors found in Dupuytren’s fascia in abnormal amounts.
Bone morphogenic protein 4 (BMP-4) is expressed by normal palmar fascia but not by the diseased fascia in reverse-transcription polymerase chain reaction studies. Therefore BMP-4 may play a protective role in normal palmar fascia.
Hypoxanthine is a byproduct of ischemia found in higher-than-normal levels in Dupuytren's tissue. This free radical may play role in triggering the change of fibroblasts to myofibroblasts in elderly hands that have ischemia from diabetes or peripheral vascular disease.

Incidence and related conditions

Most prevalent in older men of northern European descent
Global incidence estimates are 1-3% of Caucasians and increases with advancing age
Mendelian autosomal dominant inheritance with variable penetrance in 10-30% of cases
The tenascin C (TNC) gene, associated with fibrotic disease and cell migration, is up regulated in DD
Often occurs with other fibroproliferative disorders (Ledderhose disease, Peyronie’s disease, knuckle pads), which are associated with Dupuytren diathesis.

Differential diagnosis

For nodules: callus, ganglion, epithelial inclusion cyst
For contractures: chronic locked trigger fingers, ulnar nerve palsy with sign of benediction, limited joint mobility (LJM), posterior interosseous nerve palsy or Vaughan-Jackson Syndrome (ruptured extensor tendons)

Note: Limited Joint Mobility (LJM): is seen in 30-50% of type I diabetics and in 25–30% of type II diabetics. LJM causes painless flexion contractures of the PIP and/or DIP joints with pathologic cords. The ring and small fingers are most often affected. No treatment will reliably eliminate these contractures.

ICD-10 Codes

Diagnostic Guide Name

DUPUYTREN'S DISEASE

ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

DIAGNOSIS	SINGLE CODE ONLY	LEFT	RIGHT	BILATERAL (If Available)
DUPUYTREN'S DISEASE	M72.0

ICD-10 Reference

Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams

Dupuytren's Disease

Clinical presentation of Dupuytren's Disease
Guillaume Dupuytren 1777-1835
Dupuytren's Contracture fifth finger caused by classic central cord
Dupuytren's Contracture fifth finger caused by classic central cord AP view
Dupuytren's Contracture ring finger caused by central cord
Dupuytren's Contracture ring and fifth finger caused by two separate central cords
Dupuytren's Contracture fifth finger caused by an Abductor Digiti Minimi Cord
Dupuytren's Contracture with left ring central cord and natatory cord to fifth finger. On right there is a thumb-index commissurral cord, natatory cords to index, long and fifth fingers with central cord to ring.
Dupuytren's knuckle pads on dorsum of PIP joints. Sometimes first clinical sign of Dupuytren's Disease.
Dupuytren's Disease symptoms - Contractures disrupt activities of daily living.
Dupuytren's Disease symptoms - Contractures disrupt activities of daily living.
Dupuytren's Disease symptoms - Contractures disrupt activities of daily living.
Dupuytren's Disease signs - Classic positive tabletop test
Dupuytren's Disease -Clinical signs that supports symptomatic complaints and justify therapeutic intervention.
Dupuytren's Disease -Clinical signs -joint contracture measurements. Note central cords cross two joints therefore the position of one joint influences the measurement of the FC in the other joint.

Basic Science Photos and Related Diagrams

Dupuytren's Disease

Dupuytren's Disease Basic Science
Dupuytren's Disease Basic Science
Dupuytren's Disease Basic Science
Dupuytren's Disease Basic Science
Dupuytren's Disease Basic Science
Dupuytren's Disease Basic Science
Dupuytren's Disease Basic Science
Dupuytren's Disease Basic Science

Pathoanatomy Photos and Related Diagrams

Dupuytren's Disease

The Pathoanatomy of Dupuytren's Disease
On the left the normal retention pigments (fascial bands) that support the volar surface of the palm and digit. On the right the pathologic cords caused by Dupuytren's disease that originate from the fascia bands.
The pathologic cords of Dupuytren's disease that originate from the fascia bands. Note the cross sectional digital diagram with the pathologic cords.
The normal retention pigments (fascial bands) that support the volar surface of the palm and digit with a cross sectional image of the digital fascial structures.
Abductor digiti minimi cord with ulnar digital nerve and dorsal sensory nerve.
Abductor digiti minimi cord and the appropriate green injection target sites.
A Dupuyten's central cord displaced palmarly and "bowstrung" away from the flexor tendon sheath. Average distance from skin to sheath in the palm is 7mm and at the PIP level this distance is 4mm.
Classical central cord with insert showing collagenase targets
Note the thickness of this central cord (see circle). This may require transverse placement of targets.
Central cord and two natatory cords combining to form a "crow's foot" cord and contract the MP joints of three adjacent fingers. Targets for collgenase in green.
The ulnar digital nerve and dorsal sensory nerve
Central cord and natatory cord combining to form a "Y" cord and contract the MP joints of two adjacent fingers. Targets for collgenase in green.
Central cord in palm proximal to ring finger and two natatory cords combining to form a "super Y" cord and contract the MP joints of two fingers on either side of the ring finger. Targets for collagenase in green.
Commissural cord, Adductor cord and radial cord of the thumb which moves the thumb into the palm, contracts the first web and creates a thumb MP flexion contracture.

Symptoms

Flexion contractures of thumb or fingers caused by Dupuytren's cords under the skin

Firm lumps (nodules) under the skin which are usually PAINLESS!

Puckering, dimples or pits in the skin

Difficulty shaking hands, washing face or putting hand into pocket

Can't put the hand flat on a table

Can't separate the thumb from the index finger

Positive family history for Dupuytren's disease

Typical History

Patients usually present when contracture becomes severe enough to interfere with their ability to perform activities of daily living, athletic activities, or work-related activities. They may complain of difficulty putting on gloves in the winter. They are often of northern European descent and have relatives with similar finger contractures. In severe cases, there may be secondary complaints of lumps in the feet; some men may have difficulties with Peyronie's disease.

Positive Tests, Exams or Signs

Joint Exam

Range of Motion: Active

Range of Motion: Passive

Sensory Exam by Nerve

Table-Top Test

Work-up Options

Magnetic Resonance Imaging - MRI without Contrast

Sonographic Studies - Ultrasound

Images (X-Ray, MRI, etc.)

Xray and MRI imaging is rarely needed in Dupuytren's disease but in recurrent contractures after fasciectomy it may necessary to distinguish a Dupuytren's cord from a displaced flexor tendon with a ruptured A-2 pulley.

Treatment Options

Conservative

Splinting has been tried but is not usually helpful
Collagenase (Xiaflex in USA, Xiapex in EU): injectable collagenase Clostridium histolyticum (CCH) affects a chemical enzymatic fasciotomy of the pathologic Dupuytren’s cords by lysis of the collagen. It does this by cleaving the bivalent bonds of the collagen helix. CCH consisted of 2 collagenase peptides in a fixed-ratio mixture of 2 purified collagenolytic enzymes, clostridial Type I collagenase (AUX-I) and clostridial Type II collagenase (AUX-II). These 2 peptides cleave the collagen type III molecule at 2 different locations. The collagen type least affected by collagenase is Type IV, which plays an important role in the basement membranes of digital arteries and nerves. This may explain why neurovascular bundles are not affected by CCH.

Operative

Percutaneous needle aponeurotomy
Fasciotomy, open or closed
Fasciectomy, limited/partial
Fasciectomy, radical
Dermofasciectomy
Arthrodesis
Amputation

Treatment Photos and Diagrams

Collagenase

Collagenase Treatment for Dupuytren's Disease
Central Cord - Injection site located in part of the cord which is most "bowstrung" (displaced away from the flexor tendons).
Initial technique for needle insertion and collagenase injection
Older Injection technique for dividing single dose into aliquots
Current dose and needle positioning technique
Latest injection technique to inject separate aliquots and keep them in the cord
Forearm and wrist position for manipulation (finger extension) procedure
Four part manipulation technique to maximize cord disruption and minimize skin tears

Needle Aponeurotomy

Needle Aponeurotomy
Needle Aponeurotomy in progress
Needle Aponeurotomy completed. Note proximity of digital nerves.

Open Surgery

Surgical treatment of Dupuytren's Disease
Dupuytren's Incisions - First two common patterns out of many choices
Dupuytren's Incisions - Second two common patterns out of many choices
Cross sectional anatomy at MP joint level and at the proximal extent of the dissection of Dupuytren's cords. Note relationship of the pathologic cords to the tendons and neuromuscular structures.
Central cords exposed with zig-zag incisions in two adjacent affect fingers.
Spiral cord moving the neuromuscular bundle proximally, superficially, and centrally.
Abductor Digiti Minimi Cord and ulnar digital nerve and dorsal ulnar sensory nerve,
"Y" Cord (Combination of a central cord and a natatory cord) to the ring and little fingers.
Standard double zig-Zag incisions with a distally based web flap.
Central cord and digital nerve
Central cord with both digital nerves exposed and flexor tendon visible proximally.
Zig-Zag incisions with distal web flap with retention sutures in place
Central cords to long and ring fingers exposed
Close up view of central cords, Skoog's pigments and location of neuromuscular bundles.
Close up view of Skoog's ligaments (superficial intermetacarpal ligaments)
Delegate handling of the flaps without excessive undermining.
Closure of simple zig-zag incision without drain.
Knuckle pads caused by Dupuytren's Disease which sometimes appear before palmar cords or nodules.
Excision of painful enlarging knuckle pad
Excised knuckle pad. Note the extensor tendon is immediately underneath and attached to the base of the knuckle pad.
Segmental fasciectomies of a Dupuytren's central cord

CPT Codes for Treatment Options

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Common Procedure Name

Xiaflex injection

CPT Description

Injection, enzyme palmar, fascial cord

CPT Code Number

20527

Common Procedure Name

Joint manipulation after Xiaflex injection

CPT Description

Manipulation palmar fascial cord post enzyme injection

CPT Code Number

26341

Common Procedure Name

Palmar fasciectomy with single digit

CPT Description

Fasciectomy, partial excision with release of each additional digit, including proximal interphalangeal joint

CPT Code Number

26123

CPT Code References

The American Medical Association (AMA) and Hand Surgery Resource, LLC have entered into a royalty free agreement which allows Hand Surgery Resource to provide our users with 75 commonly used hand surgery related CPT Codes for educational promises. For procedures associated with this Diagnostic Guide the CPT Codes are provided above. Reference materials for these codes is provided below. If the CPT Codes for the for the procedures associated with this Diagnostic Guide are not listed, then Hand Surgery Resource recommends using the references below to identify the proper CPT Codes.

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Hand Therapy

RECOMMENDED HAND SURGEON THERAPY ORDERS

Early edema control
Patient education on wound management as necessary
AROM for thumb, fingers, and wrist
Splinting introduced within day 2-3 post surgery and injection for night extension
Wound care for skin tears s/p injections with manipulations
Strengthening at week 4 may begin following surgical intervention

REVIEW OF THERAPIST INTERVENTIONS FOR DUPUYTRENS

Therapy for non-operative patient to include:

Night splint in a hand based finger extension splint
3-4 Daytime 30 minute sessions of hand based extension splint (see images)
Introduce AROM exercises, tendon glides, encourage taking breaks, intermittently throughout the day for comfort and pain reduction
Encourage functional use within comfort, do not exacerbate the disease with passive extension stretches
Heat or paraffin intermittently for comfort and self management of pain
Look out for patient complaints of CTS symptoms in more advanced cases

STATUS POST CHEMICAL INJECTION

Early hand therapist assistance and intervention:

Edema control – encourage elevation, encourage early gentle finger ROM, watch for RSD/CRPS signs.
Manage skin tears with proper non-adherent wound dressings such as oil embedded dressings
Compressive sleeves for fingers, thumb and/or hand.
At day 1 post injection, splinting and tendon gliding exercises to be introduced the same day as manipulation, 1 day of 24-hour splinting followed by 3 months of night time splinting. Patient may continue therapy for 2-3 weeks as necessary to optimize ROM and function.
Patient education –splinting to encourage maximum extension, encourage smoke free recovery, early AROM avoid excessive exercise to minimize scarring.

REVIEW OF POST OPERATIVE FASCIECTOMY FOR DUPUYTRENS

Early hand therapist assistance and intervention (fourth week post-op):

At day 2-3 post operative, edema control – encourage elevation, review AROM for fingers, wrist, and elbow watch for RSD/CRPS signs.
At day 2-3 post operative, initiate tendon glides, PROM of fingers and AROM the wrist.
As needed, initiate isolated blocking exercises for finger IP’s and for IP & MCP AROM of the thumb.
At week 1, buddy taping may be introduced to encourage full AROM motion of all digits.
At week 2-2.5, introduce scar management and introduce a scar conformer such as silicone based products, (see image below)
At week 2-2.5, scar management, scar massage with vitamin E oil / thick vitamin E cream in light circular motions with moderate pressure, 3-4 minutes twice daily.
Very light compressive sleeves for fingers and hand. Be aware of the tourniquet effect causing distal edema accumulation and restricted blood flow to the surgical site.
Introduce ice to assist in edema reduction
Patient education – functional task precautions, encourage a smoke free recovery, avoid excessive exercise to minimize scarring.
Continue AROM for fingers, wrist, elbow & shoulder AROM if needed to prevent stiffness.
Encourage finger food tasks, in hand manipulation and coin stacking to optimize AROM and function.
At week 4-5, introduce early gripping as tolerated if no wounds or excessive swelling exist.
At week 6 post-op, progress strengthening as tolerated to regain full functional use. Progress PRE’s (Progressive Resistive Exercises) with thera-putty, thumb plunger, pen clicks, paper ball rip and roll, grippers, clips, dumbbell, and work simulator if necessary.
At week 6-8, progress strengthening and work hardening/work simulation as needed.
Progress PRE’s (Progressive Resistive Exercises) with theraputty, thumb plunger, pen clicks, paper ball rip and roll, grippers, clips, dumbbell, and work simulation if necessary.

Complications

More invasive procedures are usually associated with more short-term complications
Risk factors for recurrence: early age of onset, Dupuytren’s diathesis, multifocal disease, PIP contracture, little finger contracture
Conservative treatment complications: paresthesia, pruritis, erythema, edema, infection, wound dehiscence, delayed wound healing hematoma, stiffness
Operative Complications: nerve injury, vascular injury, deep infection, loss of grip, digit loss
Complex Regional Pain Syndrome (CRPS): formerly called Reflex Sympathetic Dystrophy (RSD) can occur after a fasciectomy. Postoperative patients who are doing well may suddenly have increasing pain and swelling and decreased function without infection. This "Flare Reaction" (CRPS-like syndrome) can be treated with anti-inflammatory medications such as a Medrol dose pack and hand therapy, including progressive ROM exercises.

Outcomes

Regardless of treatment approach, immediate post-interventional improvements in contractures are generally significant. Over time, however, these tend to diminish and/or lead to recurrence
Outcomes are generally better for MP joints, for thin cords, older individuals and those with more limited disease
During fasciectomy, an associated PIP joint release has not been shown to affect long-term outcome

Video

Collagenase Injection & and finger manipulation( finger extension procedure)

Clinical Lectures on Surgery (Leçons Orales de Clinique Chirurgicale), Lectures by Baron Dupuytren & translated by A. Sidney Doane

Key Educational Points

Regardless of the type of treatment, DD can not be cured
In DD, there are increased amounts of collagen type III in the nodule, cord and surrounding fat. Total collagen increases, and the ratio of type III to type I also increases
The primary pathologic cell type associated with DD disease is the myofibroblast
In DD, the "spiral cord" displaces the neurovascular bundle volarly, superficially, and proximally; therefore, between the distal palmar and the first finger crease, the neurovascular bundle may be found between the skin and the cord
Retrovascular cords volar to Cleland’s ligament cause DIP joint contractures
PIP contractures may not resolve after fasciectomy or CCH treatment because of an attenuation of the central slip, tight collateral ligaments, volar plate or secondary to arthritic PIP joint changes
Dupuytren’s diathesis, defined as patients with a positive family history, bilateral disease, male gender, onset of disease before age 50 years, and the presence of dorsal knuckle pads or other sites of fibromatosis, are prone to higher recurrence rates than are patients without a Dupuytren’s diathesis
In DD, the transverse ligaments of the palmar aponeurosis (superficial intrametacarpal ligaments of the Skoog) are not typically involved. In the finger, the dorsal Cleland’s ligaments are also not involved
Simultaneous surgery for carpal tunnel syndrome and DD is not associated with increased complications

References

New Articles

Gajendran VK, Hentz V, Kenney D, Curtin CM. Multiple collagenase injections are safe for treatment of Dupuytren's contractures. Orthopedics 2014;37(7):e657-60. PMID: 24992063
Rizzo M, Stern PJ, Benhaim P, Hurst LC. Contemporary management of dupuytren contracture. Instr Course Lect 2014;63:131-42. PMID: 24720301
Shih B, D Wijeratne, Armstrong DJ, Lindau T, Day P, Bayat A. Identification of Biomarkers in Dupuytren’s Disease by Comparative Analysis of Fibroblasts Versus Tissue Biopsies in Disease-Specific Phenotypes. J Hand Surg;34A:124:2009. PMID: 19121738

4. Lilly SI, Stern PJ. Simultaneous carpal tunnel release and Dupuytren’s fasciectomy. J Hand Surg 2010;35A:754-757. PMID: 20438993

Reviews

Eaton C. Evidence-based medicine: Dupuytren contracture. Plast Reconstr Surg 2014;133(5):1241-51. PMID: 24776555
Ball C, Pratt AL, Nanchahal J. Optimal functional outcome measures for assessing treatment for Dupuytren's disease: a systematic review and recommendations for future practice. BMC Musculoskelet Disord 2013;14:131. PMID: 23575442
Hurst L. Dupuytren’scontracture. In:Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH (eds) Green’s Operative Hand Surgery 6th edition. Philadelphia: Elsevier 2010;141-158.
Bulstrode NW, Jemec B, Smith PJ. The complications of Dupuytren’s contracture surgery. J Hand Surg 2005; 30A(5):1021-5. PMID: 16182062
Beyermann K, Prommersberger KJ, Jacobs C, Lanz UB. Severe contracture of the proximal interphalangeal joint in Dupuytren’s disease: does capsuloligamentous release improve outcome? J Hand Surg [Br]. 2004 Jun;29(3):240-3. PMID: 15142694
Shin SS, Liu C, Chang EY, Carslson CS, Di Cesare PE. Expression of bone morphogenic proteins by Dupuytren’s fibroblasts. J Hand Surg Am 2004;29:809–814. PMID: 15465229
Bilderback K, Rayan G. The Septa of Legueu and Juvara: an anatomic study. JHS 2004;29A:494–499. PMID: 15140495
Badalamente MA, Sampson SP, Hurst LC, Dowd A, Miyasaka K. The role of transforming growth factor beta in Dupuytren’s disease. J Hand Surg Am 1996;21:210-215. PMID: 8683048

Classics

Hueston JT. Recurrent Dupuytren's contracture. Plast Reconstr Surg 1963;31:66-9. PMID: 13955493
Tubiana R. Prognosis and treatment of Dupuytren's contracture. J Bone Joint Surg Am 1955;37-A(6):1155-68. PMID: 13271462
Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA, et al. Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med 2009;361:968–979. PMID: 19726771
McFarlane RM. On the origin and spread of Dupuytren’s disease. J Hand Surg Am. 2002; 27(3):385-390. PMID: 12015711
5. Chammas M, Bousquet P, Renard E, Poirier J-L, Jaffiol C, Allieu Y: Dupuytren’s disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg 1995 20A:109-114. PMID: 7722249

Hand Therapy References

Cannon, et al. (2001). Diagnosis and Treatment Manual for Physicians and Therapists, Upper extremity Rehabilitation (4^th ed). The Hand Rehabilitation Center of Indiana.
Mackin, Callahan, Skirven, Schneider, and Osterman, (2002). Rehabilitation of the Hand and Upper Extremity, 1, (5^th ed). St Louis, MO: Mosby Year Book, Inc.
Cooper, (2014). Fundamentals of Hand Therapy; Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity, (2^nd ed). Mosby, imprint of Elsevier Inc.
Stanley and Tribuzi. (1992). Concepts in Hand Rehabilitation. F. A. Davis Company

Dupuytren's Disease Historical References

Thurston A: Dupuytren’s disease or Cooper’s contracture?: Kenneth Fitzpatrick Russell Memorial Lecture. ANZ J Surg. 2003 Jul;73(7):529-35. PMID: 12864830
Yeh CC, Huang KF, Ho CH, Chen KT, Liu C, Wang JJ, Chu CC: Epidemiological profile of Dupuytren’s disease in Taiwan (Ethnic Chinese): a nationwide population-based study. BMC Musculoskeletal Disorders (2015) 16:20.
Ellis R: Scota, Egyptian Queen of the Scots. Epub, PDF.
Riesmeijer SA, Werker PMN, Nolte IM: Ethnic differences in prevalence of Dupuytren disease can partly be explained by known genetic risk variants. European Journal of Human Genetics, published online: 30 July 2019.
Kaya Y, Sindel A: John Hunter (1728-1793) and his legacy to science.
Moore W (2009). John Hunter (1728-1793). JLL Bulletin: Commentaries on the history of treatment evaluation (https://www.jameslindlibrary.org/articles/john-hunter-1728-93/).
Zdilla MJ: The Hand of Sabazios: Evidence of Dupuytren’s Disease in Antiquity and the Origin of the Hand of Benediction. Journal of Hand Surgery (Asian-Pacific Volume) 2017;22(3):403-410.
Ghosh SK: Human cadaveric dissection: a historical account from ancient Greece to the modern era. Anat Cell Biol 2015; 48:153-169.
Smith SB, Macchi V, Parenti A, De Caro R: Hieronymous Fabricius Ab Acquapendente (1533-1619). Clinical Anatomy 17:543 (2004).
Garcia-Guixe E, Fontaine V, Baxarias J, Nunez M, Dinares y Jesus Herrerin R (Equipo paleopatologico: Monthemhat Project). Egiptologo director excavation: Prof. Farouk Gomaa: Estudio Antropologico Paleopatologico Y Radiologico De Las Momias Localizadas En El Almacen Numero 4 De La Cases Americana (El Asasif, Luxor, Egypt): Proyecto Monthemhat 2009.
History.com Editors: German scientist discovers X-rays. https://www.history.com/this-day-in-history/german-scientist -discovers-x-rays, September 27, 2021.
Whaley DC, Elliot D: Dupuytren’s Disease: A Legacy of the North. The Journal of Hand Surgery, Vol 18B(3):363-367, June 1993.
McFarlane RM: Clinical Perspective on the Origin and Spread of Dupuytren’s Disease. The Journal of Hand Surgery, Vol 27A(3):385-390), May 2002.
Fei TT, Chernoff E, Monacco NA, Komatsu DE, Muhlrad S, Sampson SP, Hurst LC, Dagum AB: Collagenase Clostridium histolyticum for the Treatment of Distal Interphalangeal Joint Contractures in Dupuytren’s Disease. J Hand Surg Am. 2019:44(5):417.e1-e4.
McMillan C, Yeung C, Binhammer P: Variation in Treatment Recommendations for Dupuytren’s Disease. J Hand Surg Am. 2017;42(12):963-970.
Schreck MJ, Holbrook HS, Koman LA: Technique of Dynamic Flexor Digitorum Superficialis Transfer to Lateral Bands for Proximal Interphalangeal Joint Deformity Correction in Severe Dupuytren Disease. J Hand Surg Am. 2018;43(2):192.e1-e6.
Steenbeek LM, Dreise MM, Werker PMN: Durability of Collagenase Treatment for Dupuytren Disease of the Thumb and First Web After at Least 2 Years’ Follow-Up. J. Hand Surg Am. 2019;44(8):694.e1-e5.
Hacquebord JH, Chiu VY, Harness NG: The Risk of Dupuytren Surgery in Obese Individuals. J. Hand Surg Am. 2017;42(3):149-155.
Molenkamp S, van Straalen RJM, Werker PMN, Broekstra DC: Reliability and Interpretability of Sonographic Measurements of Palmar Dupuytren’ Nodule. J. Hand Surg Am. 2020;45(6):488-494.
Grandizio LC, Akoon A, Heimbach J, Graham J, Klena JC: The Use of Residual Collagenase for Single Digits With Multiple-Joint Dupuytren Contractures. J Hand Surg Am. 2017;42(6):472.e1-e6.
Samargandi OA, Alyouha S, Larouche P, Corkum JP, Kemler MA, Tang DT. Night Orthosis After Surgical Correction of Dupuytren Contractures: A Systematic Review. J Hand Surg Am. 2017;42(10):839.e1-e10.
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