Dupuytrens Contracture

Other Names

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

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Background

• This page refers to Dupuytrens Contracture or Palmar Fibromatosis

Epidemiology

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

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Pathophysiology

A mild case of Dupuytren's affecting the 4th digit.

• 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

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Risk Factors

• Gender
  • Male > Female
• Ethnicity
  • Caucasian
• Diseases
  • HIV
  • Alcoholism
  • Diabetes Mellitus
  • Tobacco Use Disorder
  • Thyroid Disease
  • Liver Disease
  • Hand Trauma
  • Epilepsy
  • Plantar Fibromatosis
  • Peyronie Disease
• Medications
  • Antiseizure medications

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Differential Diagnosis

• Fractures
  • Phalanx Fractures (Hand)
  • Metacarpal Fractures
    • Boxer's Fracture
    • Rolando Fracture
    • Bennett Fracture
• Dislocations
  • Metacarpophalangeal Joint Dislocation
  • Proximal Interphalangeal Joint Dislocation
  • Distal Interphalangeal Joint Dislocation
  • Carpometacarpal Joint Dislocation
• Tendinopathies
  • Extensor Tendon Injuries (Hand)
  • Central Slip Extensor Tendon Injury
  • Flexor Tendon Injuries (Hand)
  • Boutonniere Deformity
  • Swan Neck Deformity
  • Jersey Finger
  • Mallet Finger
  • Trigger Finger
  • De Quervains Tenosynovitis
  • Volar Plate Avulsion Injury
  • Sagittal Band Injury
• Ligament Injuries
  • Gamekeepers Thumb (UCL)
  • Radial Collateral Ligament of the Thumb Injury (RCL)
• Neuropathies
  • Wartenbergs Syndrome
  • Carpal Tunnel Syndrome
  • Guyon Canal Syndrome
• Arthropathies
  • Carpometacarpal Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
• Nail Bed Injuries
  • Nail Bed Lacerations
  • Nail Bed Avulsions
  • Subungual Hematoma
  • Paronychia
  • Felon
• Pediatric Considerations
  • Proximal Phalanx Avulsion Fracture (Thumb)
  • Middle and Distal Phalanx Avulsion Fracture
• Other
  • Dupuytrens Contracture

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Clinical Features

• 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
  • Table Top Test: Inability to flatten hand out on table

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Evaluation

• Primarily a clinical diagnosis

Radiographs

• Standard Radiographs Hand
  • Useful to evaluate for other pathology

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Classification

• N/A

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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

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Rehab and Return to Play

Rehabilitation

• Needs to be updated

Return to Play/ Work

• Needs to be updated

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Complications and Prognosis

Prognosis

• Recurrence rate is high

Complications

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

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See Also

• Finger Pain (Main)
• Hand Pain (Main)
• Wrist Pain (Main)
• Physical Exam Hand
• Hand and Wrist Anatomy (Main)

External

• Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/

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