Dupuytren contracture

Introduction

A disorder of the palmar fascia characterized by flexion deformity of the 4th & 5th digits.

Epidemiology

• most common age 40-60
• male:female ratio 10:1
• Scandanavians & northern Europeans

Pathology

• modular fibroblast proliferation
• thickening & shortening of the fibrous bands on the palmar surface of the hands & fingers

Clinical manifestations

• generally asymptomatic
• flexion deformity & interference with use of hands
• ring finger most commonly affected
• isolated painless nodules harden & mature into a cord
• generally begins distal to the palmar crease
• overlying skin becomes adherent to fascia
• contraction of fibrous cord pulls finger into flexion
• 5th finger generally 2nd finger involved
• soft tissue pads in knuckles may occur

Complications

• 5% of patients develop similar condition elsewhere
  • Peyronie's disease
  • Ledderhose disease

Differential diagnosis

• soft tissue tumor
• tendon cyst

Management

• stretching exercises
• local heat
• surgery*: fasciectomy (contraction or pain)
  • limited fasciectomy favored over collagenase injections
• collagenase injections:
  • collagenase clostridium histolyticum
  • 0.58 mg into the contracted collagen cord
  • injections every 30-day intervals
  • joint manipulation one day after injection
• needle fasciotomy

* surgery more successful than collagenase injections or needle fasciotomy (78% vs 65%)

More general terms

• joint contracture