Dupuytren's Contracture

Dupuytren's Contracture

Dupuytren's Contracture is a progressive flexion deformity of the fingers, typically affecting the 4^th (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.

Etiology

- 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:

o Liver disease

o Diabetes

o Epilepsy

- 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:

o The hand can’t be placed flat on a flat surface

o 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.