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Dupuytren's Disease
Aka: Dupuytren's Disease, Dupuytren's Contracture
- Definition
- Idiopathic contractures of the palmar fascia
- Epidemiology
- Onset after age 40 years
- More common in men
- Highest Incidence regions
- Northern Scotland
- Iceland
- Norway
- Australia
- Risk Factors
- Diabetes Mellitus (comorbid in 3-33% of diabetes)
- Mild cases with slow progression
- Increased weekly Alcohol intake
- Dupuytren's does not suggest Alcoholism
- Tobacco use
- Trauma (inconsistent association from studies)
- Anticonvulsants (inconsistent association from studies)
- Pathophysiology
- Progressive contractures of the palmar fascia
- Proliferating vascular fibrous tissue
- Collagen formation
- Results in flexion deformity of distal palm and fingers
- Unknown underlying etiology
- Often bilateral
- Autosomal Dominant inheritance, incomplete penetrance
- Associated Conditions: Other fibrous contractures
- Plantar Fibromatosis
- Peyronie's Disease
- Signs
- Distribution
- Fourth finger (most commonly involved)
- Fifth finger
- Third finger
- Second finger (least commonly involved)
- Initial: Isolated Nodule at finger forms
- Nodule hardens under distal palm
- Nodule eventually resorbs
- Next: Overlying skin adheres to fascia
- Strong fibrous cord develops and extends into finger
- Cord contracts and pulls finger into flexion
- Last: Deformity contracture of fingers
- Interference with hand use by contracted fingers
- Hueston tabletop test
- Patient unable to lay palm flat on tabletop
- Grading
- Grade 1: Thickened Nodule/band in palmar aponeurosis
- Grade 2: Peritendinous band; limited finger extension
- Grade 3: Flexion contracture of finger
- Management: Conservative (Grade 1)
- StretchingExercises
- Dupuytren's Nodule Corticosteroid Injection
- Management: Hand surgery
- Indications for hand surgery referral
- Impaired function
- Progressive contracture or disabling deformity
- MCP contracture >30 degrees of flexion
- PIP contracture of any degree
- Surgical correction is ultimately needed in most cases
- If corrected early, complete extension is expected
- Fasciotomy indications
- MCP contracture >40 degrees
- PIP contractures >20 degrees
- Surgical procedures
- Incisional Fasciotomy
- Percutaneous Needle Fasciotomy (common in Europe)
- In-Office procedure under Local Anesthesia
- Foucher (2003) J hand Surg 28:427-31 [PubMed]
- Prognosis
- Typical course is gradual progressive worsening
- Regresses spontaneously in 10% of cases
- Worse prognosis factors (faster or severe progression)
- Age under 50 years
- Tobacco use
- Alcohol use
- Worse prognosis following surgery
- PIP joint contractures
- Prognosis worsens the longer a deformity is present
- References
- Bayat (2006) Ann R Coll Surg Engl 88:3-8 [PubMed]
- Thurston (2003) J Bone Joint Surg Br 85:469-77 [PubMed]
- Trojian (2007) Am Fam Physician 76:86-90 [PubMed]