II. Definitions

  1. Dupuytren's Contracture (Palmar Fibromatosis)
    1. Idiopathic contractures of the palmar fascia

III. Epidemiology

  1. Onset after age 40 years
  2. More common in men
  3. Highest Incidence regions (northern european descent)
    1. Northern Scotland
    2. Iceland
    3. Norway
    4. Australia

IV. Risk Factors

  1. Diabetes Mellitus (comorbid in 3-33% of diabetes)
    1. Mild cases with slow progression
  2. Increased weekly Alcohol intake
    1. Dupuytren's does not suggest Alcoholism
  3. Tobacco use
  4. Trauma (inconsistent association from studies)
    1. Repetitive occupational Hand Overuse or vibrational exposure
  5. Anticonvulsants (inconsistent association from studies)
  6. Family History
    1. Develops in up to 68% of male relatives of affected patients
    2. Becker (2015) Clin Genet 87(5): 483-7 [PubMed]

V. Pathophysiology

  1. Progressive contractures of the palmar fascia
    1. Proliferating vascular fibrous tissue
    2. Collagen formation
  2. Results in flexion deformity of distal palm and fingers
  3. Unknown underlying etiology
  4. Often bilateral
  5. Autosomal Dominant inheritance, incomplete penetrance

VI. Associated Conditions: Other fibrous contractures

VII. Signs

  1. Distribution
    1. Fourth finger (most commonly involved)
    2. Fifth finger
    3. Third finger
    4. Second finger (least commonly involved)
  2. Initial: Isolated Nodule at finger forms
    1. Nodule hardens under distal palm
    2. Nodule eventually resorbs
  3. Next: Overlying skin adheres to fascia
    1. Strong fibrous cord develops and extends into finger
    2. Cord contracts and pulls finger into flexion (esp. at MCP and PIP)
    3. Skin puckers on the distal palm
  4. Last: Deformity contracture of fingers
    1. Interference with hand use by contracted fingers
  5. Hueston tabletop test
    1. Patient unable to lay palm flat on tabletop

VIII. Grading

  1. Grade 1: Thickened Nodule/band in palmar aponeurosis
  2. Grade 2: Peritendinous band; limited finger extension
  3. Grade 3: Flexion contracture of finger

IX. Management: Conservative (Grade 1)

X. Management: Hand surgery

  1. Indications for hand surgery referral
    1. Impaired function
    2. Progressive contracture or disabling deformity
    3. MCP contracture >30 degrees of flexion
    4. PIP contracture of any degree
  2. Surgical correction is ultimately needed in most cases
    1. If corrected early, complete extension is expected
    2. Fasciotomy indications
      1. MCP contracture >40 degrees
      2. PIP contractures >20 degrees
  3. Surgical procedures
    1. Collagenase Injection
    2. Incisional Fasciotomy
    3. Percutaneous Needle Fasciotomy (common in Europe)
      1. In-Office procedure under Local Anesthesia
      2. Foucher (2003) J hand Surg 28:427-31 [PubMed]

XI. Prognosis

  1. Typical course is gradual progressive worsening
  2. Regresses spontaneously in 10% of cases
  3. Worse prognosis factors (faster or severe progression)
    1. Age under 50 years
    2. Tobacco use
    3. Alcohol use
  4. Worse prognosis following surgery
    1. PIP joint contractures
    2. Prognosis worsens the longer a deformity is present

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Related Studies

Ontology: Dupuytren Contracture (C0013312)

Definition (NCI) A superficial fibromatosis arising from the soft tissue of the palm. It is characterized by the presence of spindle-shaped fibroblasts, and an infiltrative growth pattern. It predominantly affects adult males.
Definition (MSH) A fibromatosis of the palmar fascia characterized by thickening and contracture of the fibrous bands on the palmar surfaces of the hand and fingers. It arises most commonly in men between the ages of 30 and 50.
Concepts Disease or Syndrome (T047)
MSH D004387
ICD9 728.6
ICD10 M72.0
SnomedCT 274142002, 203047009, 410812005, 203045001, 51370006, 77666004, 203044002, 156724004, 410813000
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Dutch contractuur van fascia palmaris, palmaire fibromatosis, Dupuytren; contractuur, contractuur; Dupuytren, fascia palmaris; retractie, fibromatose; palmair, palmair; fibromatose, retractie; fascia palmaris, Fibromatose van fascia palmaris [Dupuytren], Contractuur, Dupuytren-, Dupuytren-contractuur
French Contracture de Dupuytren, Contracture de l'aponévrose palmaire, MALADIE DE DUPUYTREN, Aponévrosite palmaire, Rétraction de l'aponévrose palmaire, Fibromatose palmaire, Maladie de Dupuytren
German Kontraktur der Palmarfaszie, DUPUYTREN KONTRAKTUR, Fibromatose der Palmarfaszie [Dupuytren-Kontraktur], Palmarfibromatose, Dupuytren Kontraktur, Dupuytren-Kontraktur
Italian Contrattura della fascia palmare, Fibromatosi palmare, Contrattura di Dupuytren
Portuguese Contractura da fáscia palmar, DOENCA DE DUPUYTREN, Fibromatose palmar, Contractura de Dupuytren, Contratura de Dupuytren
Spanish Contractura de la fascia palmar, DUPUYTREN, ENFERMEDAD, Fibromatosis palmar, Dupuytren's disease of palm, fibromatosis palmar (trastorno), fibromatosis palmar, enfermedad de Dupuytren de las palmas, con contractura (trastorno), enfermedad de Dupuytren de las palmas, con contractura, Enfermedad de Dupuytren, contractura de Dupuytren (trastorno), contractura de Dupuytren, contractura de la fascia palmar, enfermedad de Dupuytren (trastorno), enfermedad de Dupuytren, contractura de la fascia palmar (trastorno), enfermedad de Dupuytren de la palma (trastorno), enfermedad de Dupuytren de la palma, fibromatosis fascial palmar, Contractura de Dupuytren
Japanese デュプイトレン拘縮, 手掌筋膜拘縮, デュプイトラン拘縮, シュショウキンマクコウシュク, デュプイトレンコウシュク, デュプイトランコウシュク, Dupuytren拘縮, シュショウセンイシュショウ, 手掌線維腫症, デュピュイトラン拘縮
Swedish Dupuytrens kontraktur
Czech Dupuytrenova kontraktura, Kontraktura palmární aponeurózy, Dupuytrenova nemoc, Dupuytrenova choroba, Palmární fibromatóza
Finnish Dupuytrenin kutistuskoukistuma
Russian KONTRAKTURA LADONNOGO APONEVROZA, DIUPIUITRENA KONTRAKTURA, ДЮПЮИТРЕНА КОНТРАКТУРА, КОНТРАКТУРА ЛАДОННОГО АПОНЕВРОЗА
Korean 손바닥 근막 섬유종증(뒤퓌트랑)
Croatian PALMARNA FASCIJALNA FIBROMATOZA, DUPUYTRENOVA KONTRAKTURA
Polish Przykurcz Dupuytrena
Hungarian Dupuytren-contractura, Palmaris fascia contracturája, Palmaris fibromatosis
Norwegian Dupuytren-kontraktur, Dupuytren-sykdom, Dupuytrens kontraktur, Dupuytrens sykdom