Dupuytren’s disease digital radius IV right hand and carpal tunnel syndrome on ipsilateral hand

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Abstract

Dupuytren’s contracture is a fibroproliferative disease whose etiology and pathophysiology are unclear and controversial. It is a connective tissue disorder, which takes part in the palmar’s fibromatosis category and has common characteristics with the healing process. Dupuytren’s disease is characterized by the flexion contracture of the hand due to palmar and digital aponevrosis. It generally affects the 4th digital radius, followed by the 5th one. Without surgery, it leads to functional impotence of those digital rays and/or hand. It is associated with other diseases and situational conditions like Peyronie’s disease, the Lederhose disease (plantar fibromatosis), Garrod’s digital knuckle-pads, diabetes, epilepsy, alcoholism, micro traumatisms, stenosing tenosynovitis and not the least with carpal tunnel syndrome. The carpal tunnel syndrome is a peripheral neuropathy with the incarceration of the median nerve at the ARC level, expressed clinically by sensory and motor disturbances in the distribution territory of the median nerve, which cause functional limitations of daily activities of the patient. After the failure of the nonsurgical treatment or the appearance of the motor deficit, is established the open or endoscopic surgical treatment with the release of the median nerve. Postoperative recovery in both diseases is crucial to the functionality of the affected upper limb and to the quality of the patient’s life. The patient, a 61 years old man, admitted to the clinic for the functional impotence of the right hand, for the permanent flexion contracture of the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) of the 4th finger with extension deficit, for the damage of the thumb pulp clamp of the 4th finger, for nocturnal paresthesia of fingers I-III and pain that radiates into the fingertips. After clinical, paraclinical, imagistic and electrical investigations, surgery is practiced partial aponevrectomy, carpal ligament section, external neurolysis of the median nerve, flexor tendon tenolisys. The particularity of this case is the coexistence of two pathologies: Dupuytren’s disease and carpal tunnel syndrome, the decision to solve in the same operator time and the problem of immobilization. Reportation of this case supports previous reports in literature, such as Dupuytren’s disease and carpal tunnel syndrome are observed at the same patient, at the same time or one after another.

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