Ultrasound of Dupuytren's disease: an image of the future

Currently, treatment of Dupuytren’s disease aims at surgical relief of symptoms, which unfortunately recur often. In severe cases, recurrent surgery may eventually lead to finger-amputation. This is why one of the goals of research in the field of Dupuytren’s disease is to develop a treatment that prevents progression in an early stage. In this thesis, the value of ultrasound as new measurement instrument for patients with an early disease stage was investigated. The literature was systematically reviewed, which showed that the main value of ultrasound seems to lie in the measurement of disease stage and for the evaluation of non-surgical treatments. Furthermore, we found that ultrasound is reliable in the measurement of nodule-size, especially when consecutive measurements are performed by the same observer. This means that ultrasound can be used to monitor progression and follow-up the effect of preventive treatments. Also, we found that the amount of ultrasound waves that is reflected by Dupuytren’s nodules is related to the amount of myofibroblasts, which are the cells responsible for matrix-deposition and the development of contractures. This means that ultrasound can probably be used to select the nodules that are at risk of progression and are hereby eligible for preventive treatment. We investigated if ultrasound can predict disease progression, measured as growth of nodules one year after sonographic measurement and as recurrence following minimally invasive surgery. Unfortunately, these findings were non-significant. Finally we found that minimally invasive surgery (percutaneous needle fasciotomy) for Dupuytren’s disease, guided by ultrasound, is safe and effective.