Morphological patterns of the pretendinous cord in Dupuytren’s disease: a predictor of clinical outcome?

Abstract

The morphology of the pretendinous cord in Dupuytren’s disease is poorly described in vivo and especially with respect to recurrence after treatment. This prospective study was designed to describe the morphology of Dupuytren’s cords by ultrasound and to identify possible correlation between the ultrasonographic characteristics of these cords and the clinical outcomes two years after treatment. Thirty-nine patients with a contracture of at least 20° in the metacarpophalangeal (MCP) joint, who were scheduled for local treatment by either injectable collagenase clostridium histolyticum (CCH) or percutaneous needle fasciotomy (PNF), were examined by ultrasound. The echogenicity and position of the pretendinous cords in relation to flexor tendons and neurovascular bundles were categorized. The structure of the cords was described and characterized as predominantly nodular or fibrillar. All 39 patients were assessed clinically after two years. A majority of the patients (84%) had cords with nodular components, and six patients (16%) had fibrillar cords. After two years, the clinical results were compared to the ultrasonographic findings before treatment. Three patients had recurrent contracture, and a retrospective analysis showed that all of these patients had cords with mixed echogenicity and nodules before treatment. Fifteen patients had a palpable pretendinous cord, and all but one of these had cords with mixed echogenicity and nodular structure before treatment. This pilot study indicates that some ultrasonographic features of the Dupuytren’s cord, such as mixed echogenicity and nodular structure, may predict recurrence after minimally invasive treatment for Dupuytren’s contracture. However, a larger study in correlation with histological examination of the excised cords would be necessary to confirm the pathoanatomical significance of these ultrasonographic features.

Keywords:

• Dupuytren’s disease
• Dupuytren’s cord
• ultrasound
• ultrasonographic evaluation
• colour Doppler
• collagenase
• needle fasciotomy

Acknowledgements

This investigation conforms to the University of Gothenburg Human Resource Protection Program guidelines. The authors would like to thank physiotherapist Marie Medbo for the follow-up at one year and Lena Nyblom-Andersson for administration of patient data and logistics for the study.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

Funding for this project was provided by Sahlgrenska University Hospital and the University of Gothenburg, Sweden.