Dupuytren contracture is an inherited disease of progressive fibrous tissue contracture of the palmar fascia.
Predominantly affects men of northern European descent >40 years old who smoke, drink alcohol, or have diabetes.
Patients present with a small lump or multiple lumps with pits in the palm of the hand, progressing to contractures of the fingers.
Intralesional corticosteroid injections have been shown to reduce the need for surgery.
Surgical referral should be made when metacarpophalangeal joint contractures reach 30°, or if any degree of proximal interphalangeal joint contracture is present.
Percutaneous needle fasciotomy and collagenase injections are significant therapeutic alternatives to surgery.
An inherited disease of progressive fibrous tissue contracture of the palmar fascia, Dupuytren contracture is seen predominantly in men of northern European descent aged >40 years. Its inheritance pattern is believed to be autosomal dominant with variable penetrance.
History and exam
Key diagnostic 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 nodes
- involvement of plantar surface of the feet
- involvement of penis
- male sex
- age >40 years
- family history
- diabetes mellitus
- high alcohol intake
- anticonvulsant medication
Investigations to consider
- ultrasound of hand
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
- Trigger finger
- Epithelioid sarcoma
- Dutch multidisciplinary guideline on Dupuytren disease
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