Dupuytren's Contracture

Original article by Tom Leach | Last updated on 16/5/2014
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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.

It is usually painless, and can affect one or both hands.
 

Epidemiology

  • 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.
 

Aetiology

  • 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
 

Presentation

  • 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
 

Management

  • 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.
Dupuytrens Contracture Dupuytren's Contracture Post Surgery

Dupuytren's Contracture

Dupuytren's Contracure after surgery