Dupuytren's contracture

Also called palmar fibromatosis and Dupuytren disease

Risk factors

• Genetics
• Ethnicity
• Workers exposed to repetitive handling or vibration
• Diabetes
• Smoking and alcohol

Aetiology

• Unknown

Pathophysiology

• Progressive fibrosis of the palmar fascia - fibroblastic proliferation and disorderly collagen deposition
• Benign, slowly progressive fibroproliferative disease
• Starts as a nodule, progresses to cords and joint stiffness and loss of full extension over decades

Presentation

• Usually painless
• Often rubs the palms and fingers in an attempt to straighten them out
• Most commonly fourth, then fifth fingers

Diagnosis

• Clinical - history of painless loss of finger extension
• Palpable clinical findings

Treatment

• Mild: protect fingers/hand while working (gloves); no evidence for massage or stretching
• Persistent/progressive symptoms: intralesional glucocorticoid injection if local tenderness is bothersome
• Contractures or functional impairment: surgery
  • Better long-term outcomes than percutaneous approaches
  • Some say need an angle >30-40 degrees at MCPJ to benefit
  • Either transect cords (fasciotomy) or excise diseased cords (fasciectomy), with or without excision of the overlying skin