Dupuytrens Contracture

Superficial fibromatosis that starts in the hand

Aetiology

  • Genetic predisposition
    • Autosomal dominant mutation with variable penetration
    • Common in northern Europe
    • Higher incidence in males
  • Environmental factors
    • Diabetes melletus
    • Alcohol/cirrhosis
    • Smoking
    • Epilepsy/epileptic medication
    • Repetitive trauma or from an acute injury to the hand

Pathophysiology

  • Excessive myofibroblast proliferation and altered collagen matrix composition leads to thickened and contracted palpar fascia
  • The thickening and contracture of the subdermal fascia leads to fixed flexion deformity of fingers (NOT associated with a tendon)
  • Bands are primarily collagen type III

Clinical presentation

Symptoms

  • Painless, gradual progression
  • Usually starts as palmar pit/nodule
  • Flexion contracture of affected fingers, 4th and 5th fingers are the most commonly involved
  • Dupuytrens diathesis - severe form of Dupuytrens involving little and ring fingers, Lederhosen's (superficial fibromatosis of the foot) and Peyronie's (superficial fibromatosis of the penis)
notion image

Signs

  • Palpate cords
  • MCP/PIP joint involvement - measure angles
  • Table-top test - inability to flatten the palm against the surface of a table due to the contractures in the metacarpophalangeal joints

Investigations

  • Usually clinical diagnosis

Management

  • Conservative - observation, stretches, activity modification
  • Surgery - needle fasioctomy (single band), limited fasciectomy (removal of the bands) dermofasciectomy + graft (removal of the band, adherent/contracted skin and covering graft)