0:00 Jupiter's contracture is a progressive hand disorder characterized by gradual 0:16 thickening 0:17 and tightening of fibrous tissue in the palm, leading to the bending of one or 0:22 more fingers 0:23 towards the palm, restricting their full extension. 0:28 This condition predominantly affects the ring and little finger, and can impair 0:32 hand function, 0:33 making everyday tasks challenging. 0:41 The exact cause of Jupiter's contracture remain unclear, though it is believed 0:46 to involve 0:47 a combination of genetic and environmental factors. 0:52 The condition is more common in individuals of Northern European descent, and 0:57 tends to 0:58 run in families, suggesting a hereditary component. 1:02 Environmental factors such as alcohol use, smoking and diabetes have also been 1:06 associated 1:07 with an increased risk of developing this condition. 1:16 Jupiter's contracture results from abnormal proliferation of myofibroblasts. 1:24 If we look at a normal palm, you can see that it's made up of epithelial cells, 1:29 fat 1:31 and connective tissue. 1:33 In Jupiter's contracture, you get abnormal proliferation of myofibroblasts in 1:40 the palm 1:41 of fascia, the fibrous layer beneath the skin of the palm. 1:46 These cells then produce a lot of collagen and other extracellular matrix 1:53 components, 1:54 leading to the formation of nodules and cords that can gradually contract and 1:59 pull the finger 2:00 towards the palm, creating that flexion deformity. 2:10 Let's look at the clinical features. 2:13 The onset of Jupiter's contracture is typically gradual, starting with 2:18 development of nodules 2:20 in the palm, which may or may not be painful. 2:24 As the condition progresses over time, these nodules can extend to form thick 2:31 fibrous cords 2:32 extending into the fingers. 2:35 The contracture of these cords leads to the characteristic flexion deformity of 2:40 the affected 2:41 fingers. 2:42 Patients often report difficulty in performing tasks that require a flat hand, 2:46 such as putting 2:47 on gloves or shaking hands. 2:50 In advanced cases, the contracture can significantly impair hand function. 3:00 There are other differential diagnoses to consider in someone who has something 3:05 like 3:06 Jupiter's contracture, and this includes what's called a trigger finger. 3:10 Trigger finger. 3:12 In both these conditions, they involve the hand and can restrict finger 3:16 movement, however, 3:17 in trigger finger, it's characterized by locking or catching of a finger in a 3:22 bent position, 3:24 due to inflammation of the flexotenden sheath. 3:33 A ganglion cyst is another differential, and arises near tendons or joints of 3:38 the wrist 3:38 or hands. 3:40 It really potentially causes a lump like structure, similar to the nodules of 3:46 Jupiter's contracture. 3:48 However, these lumps are cysts and are fluid-filled, whereas dupertrins nodules 3:56 are solid fibrous 3:58 tissue. 4:04 Another differential is diabetic carryoarthropathy. 4:08 It's seen in patients with long-standing diabetes, and in this condition, it 4:12 causes stiffness 4:14 and thickening of the skin of the hands. 4:18 The key distinguishing feature is the prayer sign, indicating that the person 4:24 is unable 4:25 to oppose the palms and fingers due to the skin and soft tissue being stiff. 4:30 It's really the whole hand. 4:37 Volkman's contracture is a deformity caused by ischemia in the forearm muscles, 4:42 leading 4:42 to contractures. 4:44 Unlike dupertrins, Volkman's contracture is typically the result of acute 4:49 injury, sudden 4:50 injury, and affects the forearm muscles, leading to a claw-like deformity of 4:57 the hand. 4:58 Finally, another differential is scleroderma. 5:05 Scleroderma is basically when you have skin thickening and tightening, across 5:10 various parts 5:11 the body including the hands, which might mimic dupertrins, but really, in s 5:17 cleroderma, it's 5:19 all the fingers and the hands that become tight, as well, you can get 5:22 tightening elsewhere 5:23 around the body, such as legs, feet, as well as organs, internal organs. 5:35 The diagnosis of dupertrins' contracture is primarily clinical, based on the 5:39 characteristic 5:40 appearance and symptoms. 5:42 The tabletop test is where the patient is unable to lay their hands flat on the 5:46 table, can be 5:47 a useful diagnostic tool. 5:49 Imaging studies are not typically required, but may be used to assess the 5:52 extent of the 5:52 disease in severe cases. 5:54 Remember, the most common fingers affected are really the ring finger and the 5:58 little 5:59 finger. 6:05 The treatment of dupertrins' contracture is aimed at improving hand function, 6:08 and may 6:09 include observation, especially in mild cases, when the deformity has not much 6:15 impact on hand 6:16 function. 6:18 Then there is something called needle aponeurootomy, a minimally invasive 6:23 procedure where a needle 6:25 is used to puncture and break the fibrous cords that have formed, allowing for 6:31 improved 6:32 finger extension. 6:34 This procedure can be performed in an outpatient setting with local anesthesia. 6:40 Then there's something called collagenase injection. 6:43 In this procedure, collagenase-clostridium histolyticum is injected into the 6:48 fibrous cord. 6:51 This causes enzymatic breakdown of the collagen, allowing the cord to be 6:56 disrupted and the 6:58 finger to straighten. 7:00 This method may require manipulation of the finger by the healthcare provider, 7:04 the day 7:05 following the injection to achieve the desired effect. 7:14 Finally surgery, and this is particularly reserved for severe cases or 7:19 recurrent cases. 7:21 Surgical options include fasciautomy, where the fibrous tissue is surgically 7:25 removed, or 7:26 in very severe cases, dermo fasciautomy, which involves the removal of both the 7:31 affected 7:32 skin and the underlying fibrous tissue, sometimes requiring skin grafting. 7:43 The progression of dupergis contracture can vary significantly among 7:46 individuals. 7:47 Some may experience only mild symptoms with little progression over time, while 7:52 others 7:52 may develop severe contracture requiring surgical intervention. 7:58 Complications of dupergis contracture are primarily related to loss of hand 8:02 function, 8:03 and the potential for recurrence after treatment. 8:11 In summary, dupergis contracture is a condition that leads to a progressive 8:16 hand deformity, 8:17 and functional impairment through the contracture of the palma fascia. 8:21 While the exact cause is not fully understood, a combination of genetic predis 8:26 position and 8:26 environmental factors are believed to play a role. 8:30 Treatment options vary, from observation and minimally invasive procedures to 8:34 surgery, 8:35 depending on the severity of the condition and its impact on the person's 8:39 quality of 8:40 life. 8:41 Thank you. 8:51 [BLANK_AUDIO]
