Dyupyuitren's contracture (palmar fibromatosis) – not inflammatory disease in the course of which there is a cicatricial regeneration of palmar sinews. Because of growth of connecting tissue of sinew are shortened, extension of one or several fingers is limited, develops a sgibatelny contracture with partial loss of function of a brush. Is followed by emergence of a dense knotty tyazh in the affected sinews. In mild cases insignificant restriction of extension is observed, when progressing rigidity or even an anchylosis (a full immovability) of the injured finger or fingers can develop. The causes of a disease are still unknown. At early stages perhaps conservative treatment, however in most cases Dyupyuitren's contracture progresses, and in the most effective way of its treatment there is a surgery.
Dyupyuitren's contracture – excess development of connecting fabric in sinews of sgibatel of one or several fingers. Process is localized on a palm. Develops gradually, arises for the obscure reasons. Leads to restriction of extension and formation of a sgibatelny contracture of one or several fingers. At early stages of a disease conservative techniques are applied, however the most effective way of treatment is operation.
Dyupyuitren's contracture – a disease, rather widespread in orthopedics and traumatology, which is more often observed at men of middle age. In half of cases has bilateral character. Approximately in 40% of cases the ring finger, in 35% - a little finger, in 16% - a middle finger, in 2-3% - the first and second finger is surprised. At women comes to light 6-10 times less often and proceeds more favorably. At emergence at young age more bystry progressing is characteristic.
Dyupyuitren's contracture is not connected with violations of proteinaceous, carbohydrate or salt exchange. Some authors claim that a certain communication between developing of a disease and diabetes is observed, however this theory is not proved yet.
Exist also traumatic (owing to a trauma), constitutional (hereditary features of a structure of a palmar aponeurosis) and nevrogenny (damage of peripheral nerves) theories, however opinions of scientists remain contradictory. In favor of the constitutional theory hereditary predisposition testifies. In 25-30% of cases patients have close blood relatives having the same disease.
Dyupyuitren's contracture has very characteristic clinical picture which is difficult for confusing with symptoms of other diseases. On a palm of the patient the consolidation formed by knot and one or several hypodermic tyazha comes to light. Extension of a finger is limited.
Consolidation on a palmar surface of a brush, usually – in pyastno-phalanx joints of the IV-V fingers becomes the first sign of development of a contracture of Dyupyuitren usually. In the subsequent the dense small knot slowly increases in a size. There are tyazh departing from it to the main and then – and to an average phalanx of the affected finger. Because of shortening of a sinew at first the contracture in pyastno-phalanx, and then - and in proximal (disposed closer to the center of a body) an interphalanx joint is formed.
Skin around knot becomes more dense and is gradually accustomed to drinking with the subject fabrics. In the field of defeat cambers and retractions appear from behind it. In attempt to unbend a finger the knot and tyazh become more accurate, well visible.
Usually Dyupyuitren's contracture is formed without pains and only about 10% of patients show complaints to more or less expressed pain syndrome. Pains, as a rule, give to a forearm or even a shoulder. The progressing current is characteristic of Dyupyuitren's contracture. Speed of progressing of a disease can fluctuate and does not depend on any external circumstances.
Taking into account expressiveness of symptoms allocate three degrees of a contracture of Dyupyuitren:
- The first. On a palm the dense small knot with a diameter of 0,5-1 cm is found. Is , located on a palm or reaching area of a pyastno-phalanx joint. Sometimes morbidity at a palpation comes to light.
- The second. becomes more rough and rigid, extends to the main phalanx. Skin also grows coarse and is accustomed to drinking with a palmar aponeurosis. In the field of defeat there are visible funneled deepenings and the involved folds. The affected finger (or fingers) 100 degrees are bent in a pyastno-phalanx joint at an angle, extension is impossible.
- The third. extends to average, is more rare – on a nail phalanx. In a pyastno-phalanx joint the sgibatelny contracture with a corner of 90 or less degrees comes to light. Extension in an interphalanx joint is limited, extent of restriction can vary. In hard cases of a phalanx are located at an acute angle to each other. The incomplete dislocation or even an anchylosis is possible.
It is difficult to predict the speed of progressing of a contracture of Dyupyuitren. Sometimes insignificant restriction remains for several years or even decades, and sometimes from emergence of the first symptoms before development of rigidity there pass only several months. Also the option with a long stable current which is replaced by bystry progressing is possible.
The diagnosis Dyupyuitren's contracture is exposed on the basis of complaints of the patient and a characteristic clinical picture. During survey the doctor palpates the patient's palm, revealing knots and tyazh, and also estimates amplitude of movements in a joint.
Additional laboratory and tool researches for confirmation of the diagnosis usually are not required.
Traumatologists and orthopedists are engaged in treatment of a contracture of Dyupyuitren. Treatment can be both conservative, and quick. The choice of methods is made taking into account expressiveness of pathological changes. Conservative therapy is applied at initial stages of a konraktura of Dyupyuitren. To the patient appoint physiotreatment (thermal procedures) and special exercises for stretching of a palmar aponeurosis. The removable steaks fixing fingers in the provision of extension can be also used. As a rule, they are put on at night, and removed in the afternoon.
At a persistent pain syndrome medical blockade with hormonal medicines are used (, , a hydrocortisone etc.). Solution of medicine is mixed with local anesthetic and entered into the area of painful knot. Usually the effect of one blockade remains within 6-8 weeks. It is necessary to consider that use of hormones is among treatment methods which should be applied with care. Conservative means cannot eliminate all displays of a disease. They only slow down the speed of development of a contracture. In the only radical way of treatment there is a surgery.
Accurate recommendations about an occasion of expressiveness of symptoms at which it is necessary to carry out expeditious treatment are absent now. Making decision on surgical intervention is based on the speed of progressing of a disease and complaints of the patient to pains, restriction of movements and the difficulties connected with it at self-service or performance of professional duties.
Usually doctors recommend surgery in the presence of a sgibatelny contracture with a corner of 30 or more degrees. The operation purpose, as a rule, is excision the changed fabric and restoration of full volume of movements in joints. However in hard cases, especially – at old contractures even amputation of a finger can be offered the patient (creation of a motionless joint with fixing of a finger in functionally advantageous position) or.
Reconstructive operation for Dyupyuitren's contracture can be performed under the general anesthesia or local anesthesia. At the expressed changes from skin and a palmar aponeurosis surgical intervention happens rather long therefore in such cases the general anesthesia is recommended.
There is a set of options of a section at Dyupyuitren's contractures. The cross-section in the field of a palmar fold in combination with L-or S-shaped cuts is most widespread on the palmar surface of the main phalanxes of fingers. The choice of a concrete way is made taking into account features of an arrangement of cicatricial fabric. During operation the palmar aponeurosis is excised in whole or in part. In the presence of extensive solderings which usually are followed by thinning of skin can be required thermoplastic a free skin rag.
Then the wound is taken in and drained by the rubber graduate. The hard pressing bandage which interferes with a congestion of blood and development of new cicatricial changes is applied a palm. The hand is fixed plaster longety so that fingers were in functionally advantageous position. Seams are usually removed for the tenth day. In the subsequent to the patient appoint remedial gymnastics for restoration of volume of movements in fingers. Sometimes (especially – at early emergence and bystry progressing) within several years or decades there can be a contracture recurrence. In this case repeated operation is required.