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.

Dupuytrens Contracture	Dupuytren's Contracture Post Surgery

Notes by Tom Leach