Dupuytren's Flashcards
What is Dupuytren’s?
Progressive, painless fibroproliferative disorder of the palmar fascia leading to thickening and shortening => fixed flexion contractures
What fingers are mostly involved?
Which would be considered more severe, MCP or PIP joint involvement?
Can be any, and can even be toes
Most common are little and ring fingers
PIP joint involvement is more severe and hence should be corrected immediately
There is no direct cause for Dupuytren’s but what are the main RFs for it?
Male
Idiopathic
Diabetes
Age>50
Smoking + Alcohol
Trauma
Chronic liver disease/cirrhosis
Phenytoin
What is meant by Dupuytren’s Diathesis?
This is a more aggressive cohort which may have bilateral lesions as well as ectopic lesions including
1) Knuckle pads (Garrod’s pads)
2) Foot involvement (Ledder Disease)
3) Penis involvement (Pyronie’s disease)
What test may you perform in an OSCE specific to dupuytren’s
Heuston’s Tabletop test.
Positive if patient cannot have both the digit and the palm simultaneously on the table
You are in an OSCE station and asked to perform a hand exam on a patient you saw had dupuytren’s when walking into the station. What are you specifically going to look for/do/offer?
Dont forget signs of liver disease on the hand (Leukonychia, palmer erythema, Xanthomata, Clubbing)
And RF (Tar staining, bruising/trauma)
What are the surgical indications for a patient with Dupuytren’s?
If the surgical management for Dupuytren’s requires reconstruction, what would you use?
Full thickness Skin graft
(May be escalated to flap if needed)
Point is that it is a specialised area => no split thickness. It is an area with a lot of mobility (which is why there is a Z scar rather than a longitudinal scar)
What are all the management options for a patient presenting with dupuyten’s
4 non surgical and 4 surgical
What are your differentials for dupuytren’s?
Ulnar
Trigger finger
Tenosynovitis (infectious flexor or dequervain’s)
Previous trauma/fracture
What is complex regional pain syndrome?
It is a chronic pain condition typically after surgery or stroke where the severity and persistence of pain are disproportionate to the injury
What are the complications of Dupuytren;s and its surgery?
