Dupuytren's nodule corticosteroid injection

The spiral cord, shown by the white arrow in Figure A, can displace the neurvascular bundle (blue arrow) and places it at risk during surgical resection. Dupuytren's contracture is a rare and progressive condition characterized by contractures of the fascia of the hand as seen in Illustration A. The fascial components involved in the disease include the pretendinous bands, spiral bands, natatory bands, lateral digital sheets, and Grayson's ligament. The offending cell is the myofibroblast which causes the normal structures to become fibrosed. Once these normal bands become pathologically involved in the disease process, they are termed cords. An easy way to remember this is that bands are normal, and cords are abnormal. The spiral cord travels dorsal to the NVB and displaces it volarly, placing it at risk during surgical resection. Example is shown in Illustrations B. Of note, Cleland's ligament is not involved in this disease process.

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Dupuytren's contracture is a deformity of the hand due to thickening and fibrosis of the palmar aponeurosis and eventual contracture of the 4th and 5th digits. Presenting as a small hard nodule in the base of the ring finger, it tends to affect the ring and little finger as puckering and adherence of the palmar aponeurosis to the skin. Eventually the MCP and IP joints of the 4th and 5th digits become permanently flexed. This claw appearance can be distinguished from an ulnar claw in that the MCP is flexed in Dupuytren’s but hyperextended in ulnar nerve injuries.

Risks include anaesthetic complications, bleeding or infection of the wound. Specific complications include numbness near the surgical incision or along one side of the finger due to nerve damage, swelling and stiffness of the fingers or Complex Regional Pain syndrome. This is the development of a burning sensation and sharp pain that becomes much worse than normally expected for the degree of surgery. If it occurs, the syndrome usually settles down in a weeks to months, though in some cases, it may persist and require pain management. Recurrence of the Dupuytren’s contracture may develop with approximately 10% of patients requiring further surgery by 10 years. The thin skin that remains after excising the Dupuytren’s disease has reduced circulation and can exhibit slow healing, or small areas skin loss which may require dressings for several weeks to heal or in severe cases, circulation to the finger may be inadequate and the finger may be lost.

Dupuytren's nodule corticosteroid injection

dupuytren's nodule corticosteroid injection

Risks include anaesthetic complications, bleeding or infection of the wound. Specific complications include numbness near the surgical incision or along one side of the finger due to nerve damage, swelling and stiffness of the fingers or Complex Regional Pain syndrome. This is the development of a burning sensation and sharp pain that becomes much worse than normally expected for the degree of surgery. If it occurs, the syndrome usually settles down in a weeks to months, though in some cases, it may persist and require pain management. Recurrence of the Dupuytren’s contracture may develop with approximately 10% of patients requiring further surgery by 10 years. The thin skin that remains after excising the Dupuytren’s disease has reduced circulation and can exhibit slow healing, or small areas skin loss which may require dressings for several weeks to heal or in severe cases, circulation to the finger may be inadequate and the finger may be lost.

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