2023-07-24T14:35:17
Physiotherapy clinic in Tambaram Are you Looking for Physiotherapy Treatment in Tambaram, Sunshine Super Speciality Physiotherapy Clinic, We Provide Electrotherapy, Exercise and Manual Therapy, Orthopedic, Neuro, Cardio, Pediatric, Sports and Geriatric Rehabilitation, Post Operative Physiotherapy Treatment, Fracture Rehabilitation, pain free movement. Pathophysiology of Dupuytren disease ✋ 👉Dupuytren disease (DD) is a fibroproliferative disease that affects the palmar hand, causing progressive, permanent and symptomatic flexion contracture of the digits. 👉The disease may cause deformity of the affected hand, limiting hand function and diminishing the patient’s quality of life. DD is considered most common in whites of northern european descent. https://pubmed.ncbi.nlm.nih.gov/16460628/ 👉The average age at onset of disease is 60 years and the incidence increases with increasing age. https://pubmed.ncbi.nlm.nih.gov/18669144/ 👉DD occurs more often in men than in women, but the sex difference in prevalence diminishes with increasing age. https://pubmed.ncbi.nlm.nih.gov/18780082/ 👉DD has been variously attributed to the presence of oxygen free radicals (https://pubmed.ncbi.nlm.nih.gov/8969433/), trauma to the palmar fascia (https://pubmed.ncbi.nlm.nih.gov/9763277/), or aberrant immune responses with altered antigen presentation (https://pubmed.ncbi.nlm.nih.gov/8181183/, https://pubmed.ncbi.nlm.nih.gov/1960491/), or to interactions between these proposed mechanisms. The presence of immune cells and related phenomena in DD‑affected tissue suggests that DD is possibly immune‑related. Mechanically, digital contracture is caused by myofibroblasts in the DD palmar fascia; however, the exact origin of this cell type remains unknown. DD is characterized by 3⃣ stages: proliferative, involutional and residual. https://pubmed.ncbi.nlm.nih.gov/21060335/.The progression through these stages varies in different individuals and can be influenced by known risk factors. 1⃣ The proliferative stage is characterized by the presence of cellular fibroblastic nodules, within which the fibroblasts do not seem to present any apparent arrangements or align with lines of stress (Figure). https://pubmed.ncbi.nlm.nih.gov/13664703/. At this stage of the disease, cells, rather than collagen, make up a large portion of the tissue, and the nodules are likely to be vascular. 2⃣ In the involutional stage, fibroblasts within the nodules align along the major lines of stress, predominately in the longitudinal axes of the hand and commonly on the ulnar side. As the contracture progresses, the nodules become smaller and increasingly ill-defined. https://pubmed.ncbi.nlm.nih.gov/21060335/ 3⃣ In the residual stage, the nodules disappear, leaving a hypocellular and tendon-like fibrous cord (Figure). Skin overlying the nodule can become fused with the underlying fascia and the cords may shorten, causing flexion contracture of the metacarpophalangeal joints (mCPJs) and proximal interphalangeal joints (PiPJs).A as a percentage of total collagen, type III collagen decreases in the latter stages of DD. https://pubmed.ncbi.nlm.nih.gov/20181770/ Figure: Histological changes observed in Dupuytren disease. https://pubmed.ncbi.nlm.nih.gov/21060335/ Compared with a | normal palmar fascia, b | the abnormal fascia in which DD nodules form is highly cellular with an increased amount of extracellular matrix. Fibroblasts within DD nodules do not align along stress lines in the early stages of the disease, but c | as the disease progresses and cords develop, cellularity is reduced and fibroblasts become aligned along the lines of stress. In addition, abnormal skin and subcutaneous fat have been proposed to be involved in the pathological process of the disease. Abbreviation: DD, Dupuytren disease. SUNSHINE ® SUPER SPECIALITY PHYSIOTHERAPY CLINIC - #DrParthiban #Sunshinephysioclinic.in #Physiotherapyclinicintambaram DR.M.P. PARTHIBAN.M.P.T (Ortho), Chief Orthopedic Physiotherapist, Call for Appointments: - 9345122177 East Tambaram, CHENNAI