CAN DUPUYTRENS CONTRACTURE BE WORK-RELATED - REVIEW OF THE EVIDENCE

Dupuytren's contracture (DC) is a disease of the palmar fascia resulti ng in thickening and contracture of fibrous bands on the palmar surfac e of the hands and fingers. For decades, a controversy has existed reg arding whether acute traumatic injury or cumulative biome chanical wor k exposure can contribute to the development of this disorder. To addr ess this controversy, this review considers the following questions: I s there evidence that DC is associated with 1) frequent or repetitive manual work; and 2) hand vibration? The published literature was searc hed for studies meeting the following criteria: 1) in English or havin g an English abstract; 2) controlled studies; 3) DC an identified heal th outcome studied; and 4) the study group exposed to repetitive or fr equent manual work, vibration, or acute traumatic injury. Relevant non -English articles identified through English abstracts were translated . The validity of studies meeting the selection criteria was assessed using a series of questions adapted from those of Stock [1991: Am J In d Med 19:87-107]. Studies that met a priori minimum levels of methodol ogic quality were taken into account to reach conclusions with respect to the above questions. Odds ratios (ORs) and 95% confidence interval s (CIs) were calculated for each study. Ten studies met the initial se lection criteria. Of these, four studies met the criteria for methodol ogic quality, one addressing the relationship between manual work and DC, and three studies of vibration and DC. No controlled studies of ac ute trauma and DC were identified. Bennett [1982: Br J Ind Med 39:98-1 00] found the prevalence of DC at a British PVC bagging and packing pl ant in which workers were exposed to repetitive manual work to be 5.5 times that at a local plant without packing, and twice the expected pr evalence in a U.K. working population previously studied by Early [196 2: J Bone Joint Surg 44B:602-613]. DC was observed more frequently amo ng vibration white finger claimants than controls by Thomas and Clarke [1992: J Soc Occup Med 42:155-158] (OR, 2.1; 95% CI, 1.1-3.9), and mo re frequently among vibration-exposed workers than controls by Bovenzi et al. [1994: Occup Environ Med 51:603-611] (OR, 2.6; 95% CI, 1.2-5.5 ). Cocco et al. [1987: Med Lav 78:386-392] found that a history of vib ration exposure occurred more frequently among cases of DC than among controls (OR, 2.3; 95% CI, 1.5-4.4). The latter two studies presented some evidence of a dose-response relationship. There is good support f or ail association between vibration exposure and DC. (C) 1996 Wiley-L iss, Inc.