title: Painful nodules and cords in Dupuytren disease.
abstract: OBJECTIVE
  The etiology of Dupuytren disease is unclear. Pain is seldom described in the literature. Patients are more often disturbed by impaired extension of the fingers. We recently treated a series of patients who had had painful nodules for more than 1 year, and we therefore decided to investigate them for a possible anatomical correlate.
  
  
  METHODS
  Biopsies were taken during surgery from patients with Dupuytren disease and stained to enable detection of neuronal tissue.
  
  
  RESULTS
  We treated 17 fingers in 10 patients. Intraoperatively, 10 showed tiny nerve branches passing into or crossing the fibrous bands or nodules. Of 13 biopsies, 6 showed nerve fibers embedded in fibrous tissue, 3 showed perineural or intraneural fibrosis or both, and 3 showed true neuromas. Enlarged Pacinian corpuscles were isolated from 1 sample. All patients were pain free after surgery.
  
  
  CONCLUSIONS
  Although Dupuytren disease is generally considered painless, we treated a series of early stage patients with painful disease. Intraoperative inspection and histological examination of tissue samples showed that nerve tissue was involved in all cases. The pain might have been due to local nerve compression by the fibromatosis or the Dupuytren disease itself. We, therefore, suggest that the indication for surgery in Dupuytren disease be extended to painful nodules for more than 1 year, even in the early stages of the disease in the absence of functional deficits, with assessment of tissue samples for histological changes in nerves.
authors.affiliation: Kantonsspital Aarau, Department of Hand Reconstructive and Plastic Surgery, Tellstrasse, Aarau, Switzerland. avoncampe@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: von Campe
authors.forename: K
authors.initials: K
authors.lastname: Mende
authors.forename: H
authors.initials: H
authors.lastname: Omaren
authors.forename: C
authors.initials: C
authors.lastname: Meuli-Simmen
mesh_terms: D000368:Aged; D001706:Biopsy; D004387:Dupuytren Contracture / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005350:Fibroma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000503:physiopathology / Q000601:surgery*; D010141:Pacinian Corpuscles / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications; D016896:Treatment Outcome