Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- male >40 years of age
- difficulties with manual activities
- palmar nodule
- palmar skin changes
- pretendinous cords
- MCP joint contracture
- proximal interphalangeal (PIP) joint contracture
- positive Hueston table-top test
Other diagnostic factors
- bilateral involvement
- Garrod's nodes
- involvement of plantar surface of the feet
- involvement of penis
Risk factors
- male sex
- age >40 years
- family history
- diabetes mellitus
- high alcohol intake
- smoking
- trauma
- anticonvulsant medication
Diagnostic investigations
Investigations to consider
- ultrasound of hand
Treatment algorithm
no MCP joint or PIP joint contracture
≤30 degrees MCP joint contracture with no PIP joint contracture
>30 degrees MCP joint contracture and/or PIP joint contracture
Contributors
Authors
Craig M. Rodner, MD
Assistant Professor
Department of Orthopaedic Surgery
University of Connecticut Health Center/New England Musculoskeletal Institute
Farmington
CT
Disclosures
CMR declares that he has no competing interests.
Acknowledgements
Dr Craig M. Rodner would like to gratefully acknowledge Dr Thomas H. Trojian and Dr Daniel M. Avery, both previous contributors to this topic. THT and DMA declare that they have no competing interests.
Peer reviewers
Carlos Wigderowitz, MD, PhD, FRCSEd
Senior Clinical Lecturer in Orthopaedic and Trauma Surgery
Department of Orthopaedics and Trauma Surgery
TORT Centre
Ninewells Hospital
Dundee
UK
Disclosures
CW declares that he has no competing interests.
Bill Townley, MD
Specialist Registrar
Plastic Surgery
Salisbury District Hospital
Salisbury
UK
Disclosures
BT is an author of a reference cited in this topic.
Zhongyu Li, MD
Assistant Professor
Orthopaedics
Wake Forest University Baptist Medical Center
Winston-Salem
NC
Disclosures
ZL declares that he has no competing interests.
References
Key articles
Karbowiak M, Holme T, Khan K, et al. Dupuytren's disease. BMJ. 2021 Jun 4;373:n1308. Abstract
Boe C, Blazar P, Iannuzzi N. Dupuytren contractures: an update of recent literature. J Hand Surg Am. 2021 Oct;46(10):896-906.Full text Abstract
Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg Am. 2000 Nov;25(6):1157-62. Abstract
Badalamente MA, Hurst LC. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren's contracture. J Hand Surg Am. 2007 Jul-Aug;32(6):767-74. Abstract
Hurst LC, Badalamente MA, Hentz VR, et al. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009 Sep 3;361(10):968-79.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Trigger finger
- Epithelioid sarcoma
- Camptodactyly
More DifferentialsGuidelines
- Dutch multidisciplinary guideline on Dupuytren disease
- Radiation therapy for early Dupuytren's disease
More Guidelines
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