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Dupuytrens Contracture

From WikiSM

Other Names

  • Dupuytren's Disease
  • Palmar Fibromatosis
  • Morbus Dupuytren
  • Viking disease
  • Celtic hand
  • Contraction of palmar fascia
  • Palmar fascial fibromatosis
  • Palmar fibromas
  • Cooper's Contracture

Background

  • This page refers to Dupuytrens Contracture or Palmar Fibromatosis

History

  • First described by Sir Astley Cooper in 1822[1]
  • Later described by Dupuytren in 1831[2]

Epidemiology

  • One of the most common fibromatoses
  • Northern European descent most affected
  • Age peaks at 65

Pathophysiology

Illustration of Dupuytrens Contracture[3]
Schematic diagram of Dupuytren’s disease stages. Evidence has shown that hypoxia due to environmental stimuli may lead to the characteristic increase in inflammatory mediators, including growth factors, following antigen presentation via HLA–T-cell interaction. In turn, fibroblasts differentiate and proliferate causing fibromatosis. This gives rise to fibrous cords and contracture. Autoantibodies have also been shown to be augmented in DD tissue. MCPJ , PIPJ . The two major pathways are autoimmunity (pathway a) and via hypoxia-mediatedfibrosis (pathway b)[4]
A mild case of Dupuytren's affecting the 4th digit.[5]

General

  • This is a benign, proliferative disorder
  • Defined by progressive palmer fascial nodules and finger contractions
  • Location: ring > small > middle > index
  • Proliferation of myofibroblasts, type III collagen

Risk Factors

Differential Diagnosis

Differential Diagnosis Finger And Hand Pain

Clinical Features

Positive table top test[6]

History

  • Loss of range of motion
  • Painful Nodules

Physical Exam: Physical Exam Hand

  • Nodules in pretendinous bands of palmer fascia
  • Evaluate both hands

Special Tests

Evaluation

  • Primarily a clinical diagnosis

Radiographs

Classification

  • N/A

Management

Nonoperative

  • Indications
    • Mild contractures
    • Comorbidies that preclude surgery
  • Physical Therapy
    • Emphasis on range of motion exercises
  • Procedures
    • Injection of collagenase
    • Needle Aponeurotomy

Operative

  • Indications
    • MCP contracture > 30°
    • PIP flexion contractures
    • Pain not an indication
  • Techniques
    • Fasciotomy
    • Fasciectomy
    • Open

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Recurrence rate is high

Complications

  • Wound necrosis
  • Hematoma
  • Neurovascular injury
  • Digital ischemia
  • Infection

See Also

External

References

  1. ↑ Thurston, Alan. "Dupuytren's disease or Cooper's contracture?: Kenneth Fitzpatrick Russell memorial lecture." ANZ journal of surgery 73.7 (2003): 529-535.
  2. ↑ Holzer, Lukas A., Vincent de Parades, and Gerold Holzer. "Guillaume Dupuytren: his life and surgical contributions." The Journal of hand surgery 38.10 (2013): 1994-1998.
  3. ↑ https://orthoinfo.aaos.org/
  4. ↑ McCarty, Sara, Farhatullah Syed, and Ardeshir Bayat. "Role of the HLA System in the Pathogenesis of Dupuytren's Disease." Hand 5.3 (2010): 241-250.
  5. ↑ Image courtesy of https://commons.wikimedia.org, "Dupuytren's Contracture"
  6. ↑ Trâmbiţaş, Cristian, et al. "Clinical and morphological outcomes after percutaneous needle fasciotomy in Dupuytren’s disease according to the contracture severity." Romanian Journal of Morphology and Embryology 62.3 (2021): 777.
Created by:
John Kiel on 2 November 2019 16:28:59
Authors:
Last edited:
6 March 2025 16:06:02
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