title: Management of Dupuytren contracture with ultrasound-guided lidocaine injection and needle aponeurotomy coupled with osteopathic manipulative treatment.
abstract: Dupuytren contracture is a debilitating disease that characteristically presents as a firm nodularity on the palmar surface of the hand with coalescing cords of soft tissue on the webs and digits. With few nonsurgical modalities providing clinical benefits, open surgical procedures are the standard of care for patients with this condition. However, recent studies have associated surgical intervention with many complications, necessitating further exploration of nonsurgical treatment options. We describe the case of a 64-year-old woman who presented with decreased extension of the fourth and fifth digits on the upper extremities bilaterally; previous conservative treatment regimens had been unsuccessful. After a diagnostic ultrasound, the patient was diagnosed as having Dupuytren contracture and underwent 5 treatments consisting of ultrasound-guided dry-needle aponeurotomy, lidocaine injections, and osteopathic manipulative treatment. During the fifth treatment session, the patient experienced dramatic relief of her symptoms after a palpable release during the manual manipulation portion of her therapeutic regimen. At 2-week follow-up, the patient was symptom-free. Based on this desirable outcome, the authors suggest future research be directed at minimally invasive therapeutic options in the management of Dupuytren contracture.
authors.affiliation: The Orthohealing Center, 10780 Santa Monica Blvd Suite 440, Los Angeles, CA 90025, USA. drsampson@orthohealing.com
authors.forename: Steven
authors.initials: S
authors.lastname: Sampson
authors.forename: Michael
authors.initials: M
authors.lastname: Meng
authors.forename: Adam
authors.initials: A
authors.lastname: Schulte
authors.forename: Drew
authors.initials: D
authors.lastname: Trainor
authors.forename: Roberto
authors.initials: R
authors.lastname: Montenegro
authors.forename: Danielle
authors.initials: D
authors.lastname: Aufiero
mesh_terms: D004387:Dupuytren Contracture / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D005205:Fascia / Q000648:ultrastructure; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D026301:Manipulation, Osteopathic; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009339:Needles; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D008012:Lidocaine