|Synonyms||Dupuytren's disease, Viking disease, contraction of palmar fascia, palmar fascial fibromatosis, palmar fibromas|
|Dupuytren's contracture of the ring finger|
|Symptoms||One or more fingers permanently bent in a flexed position, hard nodule just under the skin of the palm|
|Complications||Trouble preparing food or writing|
|Usual onset||Gradual onset in males over 50|
|Risk factors||Family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, epilepsy|
|Diagnostic method||Based on symptoms|
|Treatment||Steroid injections, clostridial collagenase injections, surgery|
Dupuytren's contracture is a condition in which one or more fingers become permanently bent in a flexed position. It usually begins as small hard nodules just under the skin of the palm. It then worsens over time until the fingers can no longer be straightened. While typically not painful some aching or itching may be present. The ring finger followed by the little and middle fingers are most commonly affected. It can interfere with preparing food, writing, and other activities.
The cause is unknown. Risk factors include family history, alcoholism, smoking, thyroid problems, liver disease, diabetes, previous hand trauma, and epilepsy. The underlying mechanism involves the formation of abnormal connective tissue within the palmar fascia. Diagnosis is usually based on symptoms.
Initial treatment is typically with steroid injections into the affected area and physical therapy. Among those who worsen, clostridial collagenase injections or surgery may be tried. While radiation therapy is used to treat this condition, the evidence for this use is poor. The condition may recur despite treatment.
Dupuytren's most often occurs in males over the age of 50. It mostly affects white people and is rare among Asians and Africans. In the United States about 5% of people are affected at some point in time, while in Norway about 30% of men over 60 years old have the condition. In the United Kingdom, about 20% of people over 65 have some form of the disease. It is named after Guillaume Dupuytren, who first described the underlying mechanism in 1833.
- 1 Signs and symptoms
- 2 Risk factors
- 3 Diagnosis
- 4 Treatment
- 4.1 Surgery
- 4.2 Less invasive treatments
- 4.3 Radiation therapy
- 4.4 Alternative medicine
- 5 Prognosis
- 6 Postoperative care
- 7 Notable cases
- 8 See also
- 9 References
- 10 External links
Signs and symptoms
Typically, Dupuytren's contracture first presents as a thickening or nodule in the palm, which initially can be with or without pain. Later in the disease process, there is painless increasing loss of range of motion of the affected fingers. The earliest sign of a contracture is a triangular “puckering” of the skin of the palm as it passes over the flexor tendon just before the flexor crease of the finger, at the metacarpophalangeal (MCP) joint. Generally, the cords or contractures are painless, but, rarely, tenosynovitis can occur and produce pain. The most common finger to be affected is the ring finger; the thumb and index finger are much less often affected. The disease begins in the palm and moves towards the fingers, with the metacarpophalangeal (MCP) joints affected before the proximal interphalangeal (PIP) joints.
In Dupuytren's contracture, the palmar fascia within the hand becomes abnormally thick, which can cause the fingers to curl and can impair finger function. The main function of the palmar fascia is to increase grip strength; thus, over time, Dupuytren's contracture decreases a person's ability to hold objects. People may report pain, aching and itching with the contractions. Normally, the palmar fascia consists of collagen type I, but in Dupuytren sufferers, the collagen changes to collagen type III, which is significantly thicker than collagen type I.
People with severe involvement often show lumps on the back of their finger joints (called “Garrod's pads”, “knuckle pads”, or “dorsal Dupuytren nodules”) and lumps in the arch of the feet (plantar fibromatosis or Ledderhose disease). In severe cases, the area where the palm meets the wrist may develop lumps. Severe Dupuytren disease may also be associated with frozen shoulder (adhesive capsulitis of shoulder), Peyronie's disease of the penis, increased risk of several types of cancer, and risk of early death, but more research is needed to clarify these relationships.
Dupuytren's contracture is a non-specific affliction but primarily affects:
- People of Scandinavian or Northern European ancestry, it has been called the "Viking disease", though it is also widespread in some Mediterranean countries (e.g., Spain and Bosnia) Dupuytren's is unusual among ethnic groups such as Chinese and Africans.
- Men rather than women; men are more likely to develop the condition)
- People over the age of 50; the likelihood of getting Dupuytren's disease increases with age
- People with a family history (60% to 70% of those afflicted have a genetic predisposition to Dupuytren's contracture)
- Smokers, especially those who smoke 25 cigarettes or more a day
- Thinner people (i.e., those with a lower-than-average body mass index)
- Manual workers
- People with a higher-than-average fasting blood glucose level
- People with previous hand injury
- People with Ledderhose disease (plantar fibromatosis)
- People with epilepsy (possibly due to anti-convulsive medication)
- People with diabetes mellitus
- People with HIV
In one study, those with stage 2 of the disease were found to have a slightly increased risk of mortality, especially from cancer.
This section needs additional citations for verification. (September 2016) (Learn how and when to remove this template message)
According to the American Dupuytren's specialist Dr Charles Eaton, there may be three types of Dupuytren's disease:
- Type 1: A very aggressive form of the disease found in only 3% of people with Dupuytren's, which can affect men under 50 with a family history of Dupuytren's. It is often associated with other symptoms such as knuckle pads and Ledderhose disease. This type is sometimes known as Dupuytren's diathesis.
- Type 2: The more normal type of Dupuytren's disease, usually found in the palm only, and which generally begins above the age of 50. According to Dr Eaton, this type may be made more severe by other factors such as diabetes or heavy manual labour.
- Type 3: A mild form of Dupuytren's which is common among diabetics or which may also be caused by certain medications such as the anti-convulsants taken by people with epilepsy. This type does not lead to full contracture of the fingers and is probably not inherited.
Treatment is indicated when the so-called table top test is positive. With this test, the person places their hand on a table. If the hand lies completely flat on the table, the test is considered negative. If the hand cannot be placed completely flat on the table, leaving a space between the table and a part of the hand as big as the diameter of a ballpoint pen, the test is considered positive and surgery or other treatment may be indicated. Additionally, finger joints may become fixed and rigid.
Treatment involves one or more different types of treatment with some hands needing repeated treatment.
Needle aponeurotomy is most effective for Stages I and II, covering 6–90 degrees of deformation of the finger. However, it is also used at other stages.
Collagenase injection is likewise most effective for Stages I and II. However, it is also used at other stages.
Hand surgery is effective at Stage I – Stage IV.
On June 12, 1831, Dupuytren performed a surgical procedure on a person with contracture of the 4th and 5th digits who had been previously told by other surgeons that the only remedy was cutting the flexor tendons. He described the condition and the operation in The Lancet in 1834  after presenting it in 1833 and posthumously in 1836 in a French publication by Hôtel-Dieu de Paris. The procedure he described was a minimally invasive needle procedure.
Because of high recurrence rates, new surgical techniques were introduced, such as fasciectomy and then dermofasciectomy. Most of the diseased tissue is removed with these procedures. [clarify] For some individuals, the partial insertion of "K wires" into either the DIP or PIP joint of the affected digit for a period of a least 21 days to fuse the joint is the only way to halt the disease's progress. After removal of the wires, the joint is fixed into flexion, which is considered preferable to fusion at extension.
In extreme cases, amputation of fingers may be needed for severe or recurrent cases or after surgical complications.
During the procedure, the person is under regional or general anesthesia. A surgical tourniquet prevents blood flow to the limb. The skin is often opened with a zig-zag incision but straight incisions with or without Z-plasty are also described and may reduce damage to neurovascular bundles. All diseased cords and fascia are excised. The excision has to be very precise to spare the neurovascular bundles. Because not all the diseased tissue is visible macroscopically, complete excision is uncertain. A 20-year review of surgical complications associated with fasciectomy showed that major complications occurred in 15.7% of cases, including digital nerve injury (3.4%), digital artery injury (2%), infection (2.4%), hematoma (2.1%), and complex regional pain syndrome (5.5%), in addition to minor complications including painful flare reactions in 9.9% of cases and wound healing complications in 22.9% of cases. After the tissue is removed, the surgeon closes the incision. In the case of a shortage of skin, the transverse part of the zig-zag incision is left open. Stitches are removed 10 days after surgery.
After surgery, the hand is wrapped in a light compressive bandage for one week. People start bending and extending their fingers as soon as the anesthesia has resolved. Hand therapy is often recommended. Approximately 6 weeks after surgery people are able to completely use their hand.
The average recurrence rate is 39% after a fasciectomy after a median interval of about 4 years.
This section needs additional citations for verification. (September 2016) (Learn how and when to remove this template message)
This section's tone or style may not reflect the encyclopedic tone used on Wikipedia. (September 2016) (Learn how and when to remove this template message)
Dermofasciectomy is a surgical procedure that is mainly used in recurrences and for people with a high chance of a recurrence of Dupuytren's contracture. Similar to a limited fasciectomy, the dermofasciectomy removes diseased cords, fascia, and the overlying skin. The skin is then closed with a skin graft, usually full-thickness, consisting of the epidermis and the entire dermis. In most cases the graft is taken from the antecubital fossa (the crease of skin at the elbow joint) or the inner side of the upper arm. This place is chosen, because the skin color best matches the palm's skin color. The skin on the inner side of the upper arm is thin and has enough skin to supply a full-thickness graft. The donor site can be closed with a direct suture.
The graft is sutured to the skin surrounding the wound. For one week the hand is protected with a dressing. The hand and arm are elevated with a sling. The dressing is then removed and careful mobilization can be started, gradually increasing in intensity. After this procedure the recurrence of the disease can be low but the re-operation and complication rate may be high.[vague]
Segmental fasciectomy with/without cellulose
Segmental fasciectomy involves excising part(s) of the contracted cord so that it disappears or no longer contracts the finger. It is less invasive than the limited fasciectomy, because not all the diseased tissue is excised and the skin incisions are smaller.
The person is placed under regional anesthesia and a surgical tourniquet is used. The skin is opened with small curved incisions over the diseased tissue. If necessary, incisions are made in the fingers. Pieces of cord and fascia of approximately one centimeter are excised. The cords are placed under maximum tension while they are cut. A scalpel is used to separate the tissues. The surgeon keeps removing small parts until the finger can fully extend. The person is encouraged to start moving his or her hand the day after surgery. They wear an extension splint for two to three weeks, except during physical therapy.
The same procedure is used in the segmental fasciectomy with cellulose implant. After the excision and a careful hemostasis, the cellulose implant is placed in a single layer in between the remaining parts of the cord.
After surgery people wear a light pressure dressing for four days, followed by an extension splint. The splint is worn continuously during nighttime for eight weeks. During the first weeks after surgery the splint may be worn during daytime.
Less invasive treatments
Percutaneous needle fasciotomy
Needle aponeurotomy is a minimally-invasive technique where the cords are weakened through the insertion and manipulation of a small needle. The cord is sectioned at as many levels as possible in the palm and fingers, depending on the location and extent of the disease, using a 25-gauge needle mounted on a 10 ml syringe. Once weakened, the offending cords can be snapped by putting tension on the finger(s) and pulling the finger(s) straight. After the treatment a small dressing is applied for 24 hours, after which people are able to use their hands normally. No splints or physiotherapy are given.
The advantage of needle aponeurotomy is the minimal intervention without incision (done in the office under local anesthesia) and the very rapid return to normal activities without need for rehabilitation, but the nodules may resume growing. A study reported postoperative gain is greater at the MCP-joint level than at the level of the IP-joint and found a reoperation rate of 24%; complications are scarce. Needle aponeurotomy may be performed on fingers that are severely bent (stage IV), and not just in early stages. A 2003 study showed 85% recurrence rate after 5 years.
A comprehensive review of the results of needle aponeurotomy in 1,013 fingers was performed by Gary M. Pess, MD, Rebecca Pess, DPT and Rachel Pess, PsyD and published in the Journal of Hand Surgery April 2012. Minimal followup was 3 years. Metacarpophalangeal joint (MP) contractures were corrected at an average of 99% and proximal interphalangeal joint (PIP) contractures at an average of 89% immediately post procedure. At final follow-up, 72% of the correction was maintained for MP joints and 31% for PIP joints. The difference between the final corrections for MP versus PIP joints was statistically significant. When a comparison was performed between people aged 55 years and older versus under 55 years, there was a statistically significant difference at both MP and PIP joints, with greater correction maintained in the older group. Gender differences were not statistically significant. Needle aponeurotomy provided successful correction to 5° or less contracture immediately post procedure in 98% (791) of MP joints and 67% (350) of PIP joints. There was recurrence of 20° or less over the original post-procedure corrected level in 80% (646) of MP joints and 35% (183) of PIP joints. Complications were rare except for skin tears, which occurred in 3.4% (34) of digits. This study showed that NA is a safe procedure that can be performed in an outpatient setting. The complication rate was low, but recurrences were frequent in younger people and for PIP contractures.
Extensive percutaneous aponeurotomy and lipografting
A technique introduced in 2011 is extensive percutaneous aponeurotomy with lipografting. This procedure also uses a needle to cut the cords. The difference with the percutaneous needle fasciotomy is that the cord is cut at many places. The cord is also separated from the skin to make place for the lipograft that is taken from the abdomen or ipsilateral flank. This technique shortens the recovery time. The fat graft results in supple skin.
Before the aponeurotomy, a liposuction is done to the abdomen and ipsilateral flank to collect the lipograft. The treatment can be performed under regional or general anesthesia. The digits are placed under maximal extension tension using a firm lead hand retractor. The surgeon makes multiple palmar puncture wounds with small nicks. The tension on the cords is crucial, because tight constricting bands are most susceptible to be cut and torn by the small nicks, whereas the relatively loose neurovascular structures are spared. After the cord is completely cut and separated from the skin the lipograft is injected under the skin. A total of about 5 to 10 ml is injected per ray.
After the treatment the person wears an extension splint for 5 to 7 days. Thereafter the person returns to normal activities and is advised to use a night splint for up to 20 weeks.
Clostridial collagenase injections have been found to be more effective than placebo. The cords are weakened through the injection of small amounts of the enzyme collagenase, which breaks peptide bonds in collagen.
The treatment with collagenase is different for the MCP joint and the PIP joint. In a MCP joint contracture the needle must be placed at the point of maximum bowstringing of the palpable cord.
The needle is placed vertically on the bowstring. The collagenase is distributed across three injection points. For the PIP joint the needle must be placed not more than 4 mm distal to palmar digital crease at 2–3 mm depth. The injection for PIP consists of one injection filled with 0.58 mg CCH 0.20 ml. The needle must be placed horizontal to the cord and also uses a 3-point distribution. After the injection the person’s hand is wrapped in bulky gauze dressing and must be elevated for the rest of the day. After 24 hours the person returns for passive digital extension to rupture the cord. Moderate pressure for 10–20 seconds ruptures the cord.
After the treatment with collagenase the person should use a night splint and perform digital flexion/extension exercises several times per day for 4 months.
Radiation therapy has been used mostly for early stage disease, but is unproven. Evidence to support its use as of 2017, however, is poor; efforts to gather evidence are complicated due to a poor understanding of the how the condition develops over time. It has only been looked at in early disease.
Several alternate therapies such as vitamin E treatment, have been studied, although without control groups. Most doctors do not value those treatments. None of these treatments stops or cures the condition permanently.
Laser treatment (using red and infrared at low power) was informally discussed in 2013 at an International Dupuytren Society forum, as of which time little or no formal evaluation of the techniques had been completed.
Only anecdotal evidence supports other compounds such as vitamin E.
Dupuytren’s disease has a high recurrence rate, especially when a person has so called Dupuytren’s diathesis. The term diathesis relates to certain features of Dupuytren's disease and indicates an aggressive course of disease.
The presence of all new Dupuytren’s diathesis factors increases the risk of recurrent Dupuytren’s disease by 71% compared with a baseline risk of 23% in people lacking the factors. In another study the prognostic value of diathesis was evaluated. They concluded that presence of diathesis can predict recurrence and extension. A scoring system was made to evaluate the risk of recurrence and extension evaluating the following values: bilateral hand involvement, little finger surgery, early onset of disease, plantar fibrosis, knuckle pads and radial side involvement.
Minimally invasive therapies may precede higher recurrence rates. Recurrence lacks a consensus definition. Furthermore, different standards and measurements follow from the various definitions.
Postoperative care involves hand therapy and splinting. Hand therapy is prescribed to optimize post-surgical function and to prevent joint stiffness.
Besides hand therapy, many surgeons advise the use of static or dynamic splints after surgery to maintain finger mobility. The splint is used to provide prolonged stretch to the healing tissues and prevent flexion contractures. Although splinting is a widely used post-operative intervention, evidence of its effectiveness is limited, leading to variation in splinting approaches. Most surgeons use clinical experience to decide whether to splint. Cited advantages include maintenance of finger extension and prevention of new flexion contractures. Cited disadvantages include joint stiffness, prolonged pain, discomfort, subsequently reduced function and edema.
A third approach emphasizes early self-exercise and stretching.
- Bill Frindall, who had a finger amputated.
- Margaret Thatcher
- Misha Dichter
- Prince Joachim of Denmark
- Ronald Reagan
- Bill Nighy
- Fitzpatrick's dermatology in general medicine (6 ed.). New York, NY [u.a.]: McGraw-Hill. 2003. p. 989. ISBN 0-07-138076-0.
- "Dupuytren contracture". Genetics Home Reference. September 2016. Archived from the original on 13 May 2017. Retrieved 3 June 2017.
- "Merriam-Webster – Dupuytren's contracture". Retrieved 12 March 2018.
- "Dupuytren's Contracture". NORD (National Organization for Rare Disorders). 2005. Archived from the original on 10 September 2017. Retrieved 3 June 2017.
- Brazzelli, M; Cruickshank, M; Tassie, E; McNamee, P; Robertson, C; Elders, A; Fraser, C; Hernandez, R; Lawrie, D; Ramsay, C (October 2015). "Collagenase clostridium histolyticum for the treatment of Dupuytren's contracture: systematic review and economic evaluation". Health technology assessment (Winchester, England). 19 (90): 1–202. doi:10.3310/hta19900. PMC . PMID 26524616.
- Kadhum, M; Smock, E; Khan, A; Fleming, A (1 March 2017). "Radiotherapy in Dupuytren's disease: a systematic review of the evidence". The Journal of hand surgery, European volume. 42: 1753193417695996. doi:10.1177/1753193417695996. PMID 28490266.
On balance, radiotherapy should be considered an unproven treatment for early Dupuytren's disease due to a scarce evidence base and unknown long-term adverse effects.
- Hart, M. G.; Hooper, G. (2005). "Clinical associations of Dupuytren's disease". Postgraduate Medical Journal. 81 (957): 425–8. doi:10.1136/pgmj.2004.027425. PMC . PMID 15998816.
- "Dupuytren's contracture – Symptoms". National Health Service (England). Archived from the original on 2016-04-08. Page last reviewed: 29/05/2015
- Lanting, Rosanne; Van Den Heuvel, Edwin R.; Westerink, Bram; Werker, Paul M. N. (2013). "Prevalence of Dupuytren Disease in the Netherlands". Plastic and Reconstructive Surgery. 132 (2): 394–403. doi:10.1097/prs.0b013e3182958a33. PMID 23897337.
- Nunn, Adam C.; Schreuder, Fred B. (2014). "Dupuytren's Contracture: Emerging Insight into a Viking Disease". Hand Surgery. 19 (3): 481–90. doi:10.1142/S0218810414300058. PMID 25288296.
- "Your Orthopaedic Connection: Dupuytren's Contracture". Archived from the original on 2007-03-13.
- Guitian, A. Quintana (1988). "Quelques aspects épidémiologiques de la maladie de Dupuytren" [Various epidemiologic aspects of Dupuytren's disease]. Annales de Chirurgie de la Main (in Spanish). 7 (3): 256–62. doi:10.1016/S0753-9053(88)80013-9. PMID 3056294.
- Zerajic, Dragan; Finsen, Vilhjalmur (2012). "The Epidemiology of Dupuytren's Disease in Bosnia". Dupuytren's Disease and Related Hyperproliferative Disorders. pp. 123–7. doi:10.1007/978-3-642-22697-7_16. ISBN 978-3-642-22696-0.
- "Age and geographic distribution of Dupuytren's disease (Dupuuytren's contracture)". Dupuytren-online.info. 2012-11-21. Archived from the original on 2013-03-16. Retrieved 2013-02-27.
- Gudmundsson, Kristján G.; Arngrı́Msson, Reynir; Sigfússon, Nikulás; Björnsson, Árni; Jónsson, Thorbjörn (2000). "Epidemiology of Dupuytren's disease". Journal of Clinical Epidemiology. 53 (3): 291–6. doi:10.1016/s0895-4356(99)00145-6. PMID 10760640.
- "Dupuytren's Contracture". Archived from the original on 2016-06-16.
- Burge, Peter; Hoy, Greg; Regan, Padraic; Milne, Ruairidh (1997). "Smoking, Alcohol and the Risk of Dupuytren's Contracture". The Journal of Bone and Joint Surgery. 79 (2): 206–10. doi:10.1302/0301-620x.79b2.6990. PMID 9119843.
- "Etiology of Dupuytren's Disease" Archived 2016-10-12 at the Wayback Machine. Living Textbook of Hand Surgery.
- Gudmundsson, Kristján G.; Arngrı́Msson, Reynir; Sigfússon, Nikulás; Jónsson, Thorbjörn (2002). "Increased total mortality and cancer mortality in men with Dupuytren's disease". Journal of Clinical Epidemiology. 55 (1): 5–10. doi:10.1016/S0895-4356(01)00413-9. PMID 11781116.
- Eaton, C. "Three types of Dupuytren Disease?" (Dupuytren's Foundation website) Archived 2016-06-13 at the Wayback Machine.
- Hindocha, Sandip; Stanley, John K.; Watson, Stewart; Bayat, Ardeshir (2006). "Dupuytren's Diathesis Revisited: Evaluation of Prognostic Indicators for Risk of Disease Recurrence". The Journal of Hand Surgery. 31 (10): 1626–34. doi:10.1016/j.jhsa.2006.09.006. PMID 17145383.
- "Progression of Dupuytren's disease". Dupuytren-online.info. 2012-08-18. Archived from the original on 2013-03-22. Retrieved 2013-02-27.
- "Clinical Lectures on Surgery". The Lancet. 22 (558): 222–5. 1834. doi:10.1016/S0140-6736(02)77708-8.
- Dupuytren, Guillaume (1836). "Rétraction Permanente des Doigts". Leçons orales de clinique chirurgicale, faites a l'Hotel-Dieu de Paris. 1: 1–12.
- Townley, W A; Baker, R; Sheppard, N; Grobbelaar, A. O. (2006). "Dupuytren's contracture unfolded". BMJ. 332 (7538): 397–400. doi:10.1136/bmj.332.7538.397. PMC . PMID 16484265.
- Skoff, H. D. (2004). "The surgical treatment of Dupuytren's contracture: A synthesis of techniques". Plastic and Reconstructive Surgery. 113 (2): 540–4. doi:10.1097/01.PRS.0000101054.80392.88. PMID 14758215.
- Khashan, Morsi; Smitham, P. J.; Khan, W. S.; Goddard, N. J. (2011). "Dupuytren's Disease: Review of the Current Literature". The Open Orthopaedics Journal. 5: 283–8. doi:10.2174/1874325001105010283. PMC . PMID 21886694.
- Van Rijssen, Annet L.; Gerbrandy, Feike S.J.; Linden, Hein Ter; Klip, Helen; Werker, Paul M.N. (2006). "A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren's Disease: A 6-Week Follow-Up Study". The Journal of Hand Surgery. 31 (5): 717–25. doi:10.1016/j.jhsa.2006.02.021. PMID 16713831.
- Robbins, T. H. (1981). "Dupuytren's contracture: The deferred Z-plasty". Annals of the Royal College of Surgeons of England. 63 (5): 357–8. PMC . PMID 7271195.
- Denkler, K (2010). "Surgical complications associated with fasciectomy for dupuytren's disease: A 20-year review of the English literature". Eplasty. 10: e15. PMC . PMID 20204055.
- Van Rijssen, A. L.; Werker, P. M. (2009). "Treatment of Dupuytren's contracture; an overview of options". Nederlands tijdschrift voor geneeskunde. 153: A129. PMID 19857298.
- Crean, S. M.; Gerber, R. A.; Le Graverand, M. P. H.; Boyd, D. M.; Cappelleri, J. C. (2011). "The efficacy and safety of fasciectomy and fasciotomy for Dupuytren's contracture in European patients: A structured review of published studies". Journal of Hand Surgery. 36 (5): 396–407. doi:10.1177/1753193410397971. PMID 21382860.
- Denkler, K (2005). "Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet". Plastic and Reconstructive Surgery. 115 (3): 802–10. doi:10.1097/01.prs.0000152420.64842.b6. PMID 15731682.
- Bismil, Q.; Bismil, M.; Bismil, A.; Neathey, J.; Gadd, J.; Roberts, S.; Brewster, J. (2012). "The development of one-stop wide-awake dupuytren's fasciectomy service: A retrospective review". JRSM Short Reports. 3 (7): 48. doi:10.1258/shorts.2012.012050. PMC . PMID 22908029.
- Armstrong, J. R.; Hurren, J. S.; Logan, A. M. (2000). "Dermofasciectomy in the management of Dupuytren's disease". The Journal of Bone and Joint Surgery. British Volume. 82 (1): 90–4. doi:10.1302/0301-620x.82b1.9808. PMID 10697321.
- Ullah, A. S.; Dias, J. J.; Bhowal, B. (2009). "Does a 'firebreak' full-thickness skin graft prevent recurrence after surgery for Dupuytren's contracture?: a prospective, randomised trial". Journal of Bone and Joint Surgery. British Volume. 91–B (3): 374–8. doi:10.1302/0301-620X.91B3.21054. PMID 19258615.
- Bainbridge, Christopher; Dahlin, Lars B.; Szczypa, Piotr P.; Cappelleri, Joseph C.; Guérin, Daniel; Gerber, Robert A. (2012). "Current trends in the surgical management of Dupuytren's disease in Europe: An analysis of patient charts". European Orthopaedics and Traumatology. 3 (1): 31–41. doi:10.1007/s12570-012-0092-z. PMC . PMID 22611457.
- Moermans, J (1991). "Segmental aponeurectomy in Dupuytren's disease". The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 16 (3): 243–54. doi:10.1016/0266-7681(91)90047-R. PMID 1960487.
- Degreef, Ilse; Tejpar, Sabine; De Smet, Luc (2011). "Improved postoperative outcome of segmental fasciectomy in Dupuytren disease by insertion of an absorbable cellulose implant". Journal of Plastic Surgery and Hand Surgery. 45 (3): 157–64. doi:10.3109/2000656X.2011.558725. PMID 21682613.
- Van Rijssen, Annet L.; Werker, Paul M.N. (2012). "Percutaneous Needle Fasciotomy for Recurrent Dupuytren Disease". The Journal of Hand Surgery. 37 (9): 1820–3. doi:10.1016/j.jhsa.2012.05.022. PMID 22763055.
- Hovius, Steven E. R.; Kan, Hester J.; Smit, Xander; Selles, Ruud W.; Cardoso, Eufimiano; Khouri, Roger K. (2011). "Extensive Percutaneous Aponeurotomy and Lipografting: A New Treatment for Dupuytren Disease". Plastic and Reconstructive Surgery. 128 (1): 221–8. doi:10.1097/PRS.0b013e31821741ba. PMID 21701337.
- Bayat, Ardeshir; Thomas (2010). "The emerging role of Clostridium histolyticum collagenase in the treatment of Dupuytren disease". Therapeutics and Clinical Risk Management. 6: 557–72. doi:10.2147/TCRM.S8591. PMC . PMID 21127696.
- Hurst, Lawrence C.; Badalamente, Marie A.; Hentz, Vincent R.; Hotchkiss, Robert N.; Kaplan, F. Thomas D.; Meals, Roy A.; Smith, Theodore M.; Rodzvilla, John (2009). "Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture". New England Journal of Medicine. 361 (10): 968–79. doi:10.1056/NEJMoa0810866. PMID 19726771.
- Lellouche, Henri (2008). "Maladie de Dupuytren : La chirurgie n'est plus obligatoire" [Dupuytren's contracture: surgery is no longer necessary]. La Presse Médicale (in French). 37 (12): 1779–81. doi:10.1016/j.lpm.2008.07.012. PMID 18922672.
- Foucher, G (2003). "Percutaneous needle aponeurotomy: Complications and results". The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 28 (5): 427–31. doi:10.1016/S0266-7681(03)00013-5. PMID 12954251.
- Van Rijssen, Annet L.; Ter Linden, Hein; Werker, Paul M. N. (2012). "Five-Year Results of a Randomized Clinical Trial on Treatment in Dupuytrenʼs Disease". Plastic and Reconstructive Surgery. 129 (2): 469–77. doi:10.1097/PRS.0b013e31823aea95. PMID 21987045.
- Pess, Gary M.; Pess, Rebecca M.; Pess, Rachel A. (2012). "Results of Needle Aponeurotomy for Dupuytren Contracture in over 1,000 Fingers". The Journal of Hand Surgery. 37 (4): 651–6. doi:10.1016/j.jhsa.2012.01.029. PMID 22464232.
- Badalamente, Marie A.; Hurst, Lawrence C. (2007). "Efficacy and Safety of Injectable Mixed Collagenase Subtypes in the Treatment of Dupuytren's Contracture". The Journal of Hand Surgery. 32 (6): 767–74. doi:10.1016/j.jhsa.2007.04.002. PMID 17606053.
- Badalamente, Marie A.; Hurst, Lawrence C. (2000). "Enzyme injection as nonsurgical treatment of Dupuytren's disease". The Journal of Hand Surgery. 25 (4): 629–36. doi:10.1053/jhsu.2000.6918. PMID 10913202.
- Badalamente, Marie A.; Hurst, Lawrence C.; Hentz, Vincent R. (2002). "Collagen as a clinical target: Nonoperative treatment of Dupuytren's disease". The Journal of Hand Surgery. 27 (5): 788–98. doi:10.1053/jhsu.2002.35299. PMID 12239666.
- "FDA Approves Xiaflex for Debilitating Hand Condition". Fda.gov. 2010-02-02. Archived from the original on 2012-11-26. Retrieved 2013-02-27.
- "Radiation therapy for early Dupuytren's disease: Guidance and guidelines". NICE. December 2016. Archived from the original on 2017-06-28.
- Proposed Natural Treatments for Dupuytren's Contracture, EBSCO Complementary and Alternative Medicine Review Board, 2 February 2011 Archived 23 July 2011 at the Wayback Machine..Accessed 21 March 2011.
- Cold Laser Treatment Archived 2013-11-09 at the Wayback Machine. at International Dupuytren Society online forum. Accessed: 28 August 2012.
- Therapies for Dupuytren's contracture and Ledderhose disease with possibly less benefit, International Dupuytren Society, 19 January 2011 Archived 14 March 2011 at the Wayback Machine..Accessed: 21 March 2011.
- Abe, Y (2004). "An objective method to evaluate the risk of recurrence and extension of dupuytren's disease". The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 29 (5): 427–30. doi:10.1016/j.jhsb.2004.06.004. PMID 15336743.
- Jerosch-Herold, Christina; Shepstone, Lee; Chojnowski, Adrian J; Larson, Debbie (2008). "Splinting after contracture release for Dupuytren's contracture (SCoRD): Protocol of a pragmatic, multi-centre, randomized controlled trial". BMC Musculoskeletal Disorders. 9: 62. doi:10.1186/1471-2474-9-62. PMC . PMID 18447898.
- Larson, Debbie; Jerosch-Herold, Christina (2008). "Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: A systematic review". BMC Musculoskeletal Disorders. 9: 104. doi:10.1186/1471-2474-9-104. PMC . PMID 18644117.
- Jonathan Agnew, Aggers' Ashes (London, 2011), page 103
- Drug Approved to Treat Hand-Crippling Syndrome Archived 2010-04-09 at the Wayback Machine., Delthia Ricks, Chicago Tribune, March 17, 2010.
- Pollack, Andrew (March 15, 2010). "Triumph for Drug to Straighten Clenched Fingers". The New York Times. Archived from the original on March 18, 2010.
- "Joachim opereret for krumme fingre". HER&NU. March 17, 2013. Archived from the original on October 29, 2013.
- Farndale, Nigel (February 8, 2015). "Bill Nighy: 'I'm greedy for beauty'". The Guardian. Archived from the original on March 23, 2017. Retrieved March 23, 2017.