Dupuytren's Contracture

Question 1

What is Dupuytren’s contracture?

Answer 1

Fascia of the hand becomes thickened and tight causing finger contractures

Question 2

What is a contracture?

Answer 2

Shortening of the soft tissues causing restricted movement

Question 3

What is the pathophysiology of Dupuytren’s contractures?

Answer 3

Palmar fascia becomes thicker and tighter developing nodules

Cords of dense connective tissue extend into fingers, pulling fingers into flexion and restricting ability to extend

Question 4

What causes thickening of the fascia?

Answer 4

Inflammatory process due to microtrauma

Question 5

What are the risk factors of Dupuytren’s contractures?

Answer 5

Age
Family history
Male
Manual labour-vibrating tools
Diabetes (type 1 more than 2)
Epilepsy
Smoking and alcohol

Question 6

What fingers are most likely and unlikely to be affected by Dupuytren’s contractures?

Answer 6

Ring finger most likely

Index least likely

Question 7

Outline how Dupuytren’s contractures form

Answer 7

1. Palmar nodules
2. Palmar skin changes
3. Pre-tendinous cords
4. MCP joints
5. PIP joints

Question 8

What test is used for Dupuytren’s contractures?

Answer 8

Table-top test

Patient positions hand flat on the table

If the hand cannot rest completely flat, the test is positive

Question 9

How are Dupuytren’s contractures managed?

Answer 9

Needle fasciotomy
Neelde through skin to divide and loosen the cord that is causing the contracture

Limited fasciectomy
Removing abnormal fascia and cord to release contracture

Dermofasciectomy
Removing abnormal fascia and cord and associated skin

Skin graft used to replace removed skin