Dupuytren Disease
Dupuytren's contracture is an inherited disease that results in progressive fibrous tissue contracture of the palmar fascia.
Risk Factors
- Male
- Northern European descent
- Age over 40
- Smoking and alcohol consumption
- Diabetes
It is believed to have an autosomal dominant inheritance pattern with variable penetrance.
Clinical Features
The patient may report difficulties with manual activities and a palmar nodule.
There is a small lump or multiple lumps with pits in the palmar aspect of the hand. These progress to contractures of the fingers.
There may be involvement of the plantar surface of the feet and penis. Bilateral disease can occur. Garrod's nodes can be present.
Investigations
Ultrasound of the hand can be considered
Differential Diagnosis
- Trigger Finger - finger can be fully extended with a click
- Epithelioid sarcoma - usually progressive and extends beyond the localised digits.
- Camptodactyly - 5th digit contracture from an early age
- Traumatic finger contracture - history of trauma
Treatment
Injections
- Intralesional corticosteroid injections
- Collagenase
- Percutaneous needle fasciotomy
Surgery
Surgery is indicated when there is metacarpophalangeal join contracture of 30 degrees, or if there is any degree of proximal interphalangeal joint contracture.
