Dupuytren's Contracture is a progressive flexion deformity of the fingers, typically affecting the 4th (ring) finger. Also commonly affects the little finger, and rarely the middle finger. It is a result of contracture and fibrosis of the palmar aponeurosis.
- More common in men (10:1)
- Increases after age 45
- Tends only to affect those of Scandinavian and Northern European origin, as well as those from the Iberian peninsula and Japan.
- It is believed that in about 70% of cases it is the result of a genetic disorder whereby susceptible individuals who are subsequently exposed to further risk factors. These factors can include:
- It can also be ideopathic
- Often a tender nodule on the palm is the first sign
- Deformity is progressive and follows later
- Pain subsides as it progresses
- Eventually the whole hand becomes arched, and there is contracture of the MCP and interphalangeal joints
- Steroid Injections are useful in early presentations of a tender nodule, and can prevent the formation of the contracture
Surgery is indicated if:
- The hand can’t be placed flat on a flat surface
- There is contracture of the PIP joints
- Surgery involves careful removal of the affected palmar aponeurosis around neurovascular bundles (which are left behind). Recurrence can occur particularly if the dissection for removal is not adequate, and/or commonly if the patient is young at the time of surgery
- Injected collagenase – is a new treatment that has been shown to reverse contracture in some patients but is not widely used.
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