April 3, 2013

DynaMed EBM Journal Volume 8, Issue 14

DynaMed Resident
DynaMed Resident Focus is an outlet for residents to share recent evidence they find important with their peers. Residents who are members of the DynaMed community are eligible to participate. If interested, please email dynamedcommunity@ebscohost.com.

About the Author

Christian Vanderkaay, MD, Chief Resident, PGY3, received his medical degree from Wayne State University School of Medicine and is currently participating in the Grand Rapids Medical Education Partners (GRMEP) Family Medicine Residency Program, in affiliation with Michigan State University College of Human Medicine. Dr. Vanderkaay currently provides peer review for Dupuytren disease with Dr. Jeff Chamberlain.

For more information about the residency program, visit the GRMEP Family Medicine webpage.

Dr. Vanderkaay has declared no financial or other competing interests.

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Performing Manual Work and Vibration Exposure Associated with Increased Risk of Developing Dupuytren Disease

Reference: BMC Musculoskeletal Disord. 2011 May 16;12:96

In Dupuytren disease, fibroblast proliferation causes thickening of the palmar fascia, ultimately leading to contractures, severe pain, and disability. It tends to be more prominent in those of European ancestry and in males. It has long been speculated that certain types of upper extremity work exposure have contributed to the formation of Dupuytren disease. As early as 1831, Baron Guillaume Dupuytren spoke of associating the disease with chronic local trauma caused by occupation, citing examples related to working with the palm of the hand or handling hard objects. This included at the time wine merchants, coachmen, whip handlers, and masons.

There are currently conflicting opinions as to whether repetitive work exposure actually contributes to the formation of Dupuytren disease. A recent systematic review addressed the issue.

The systematic review authors searched four databases using three key words: "occupational disease", "work", and "Dupuytren contracture". Two readers independently performed a selection of articles, and a quality assessment was performed. Inclusion criteria narrowed the search down to 14 studies. Relevant data were extracted from the articles, primarily in the form of manual work exposure and vibration exposure.

All the studies included were from Europe, and consisted of cohorts, case-controls and cross-sectional studies. Methods of measuring exposure included job title records, questionnaires and detailed interviews. Outcomes were measured by physical examinations conducted by physicians, medical trainees or otherwise not specified.

In the meta-analysis, manual work (using a tool with a handle, manual handling and repairing manual equipment) was associated with an increased risk of developing Dupuytren disease (odds ratio 2.02 [95% CI 1.57-2.6]) in an analysis of 12 studies. Vibration work (using a vibrational tool) was also associated with an increased risk (odds ratio 2.88 [95% CI 1.36-6.07]) in an analysis of 7 studies. When the meta-analysis was limited to more high quality studies, the results remained significant.

This analysis supports an association between manual work and vibration exposure and Dupuytren disease. The results are limited in that the studies were observational so potential bias from other factors could be present. Also, there was minimal reporting of the limitations associated with each study. Further analysis of prospective cohort studies would be beneficial to solidify evidence supporting this association.

Reference: Descatha A, Jauffret P, Chastang JF, Roquelaure Y, Leclerc A. Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate. BMC Musculoskeletal Disorders. 2011 May 16; 12:96.

For more information, see Dupuytren disease in DynaMed.