Dupuytren's Contracture

Question 1

Which tissue contracts in Dupuytren’s contracture

Answer 1

Longitudinal palmar fascia

Question 2

Progression of Dupuytren’s contracture (3)

Answer 2

1 painless nodules 2 fibrous cords form 3 flexion contractures develop

Question 3

Joints affected in Dupuytren’s contracture (3)

Answer 3

1 MCPJ 2 PIPJ

Question 4

Effect of Dupuytren’s contracture on finger

Answer 4

Limited digital movement

Question 5

Ratio of male:female in Dupuytren’s contracture

Answer 5

6:1

Question 6

Peak age of onset for Dupuytren’s contracture

Answer 6

40-60y

Question 7

Digits most affected by Dupuytren’s contracture

Answer 7

Ring and little

Question 8

Fascia affected in Leddarhose disease

Answer 8

Plantar fascia

Question 9

Fascia affected in Peyronie disease

Answer 9

Penile fascia

Question 10

Description of Garrod nodes

Answer 10

Fibromatosis of dorsal PIPJs

Question 11

Pathophysiology of Dupuytren’s contracture (3)

Answer 11

In fascia: 1 fibroplastic hyperplasia 2 altered collagen matrix 3 causing thickening and contraction

Question 12

Pattern of disease progress in Dupeytren’s contracture (4)

Answer 12

1 Pitted, thickened palm 2 fixed painless nodule 3 tendon-like cord 4 progressive flexion deformity

Question 13

Main risk factors in Dupuytren’s contracture (5)

Answer 13

1 smoking 2 alcoholic liver cirrhosis 3 family history 4 DM 5 vibration tools

Question 14

Range of presenting symptoms (early, middle, late)

Answer 14

1 nodular deformity 2 reduced ROM 3 complete loss of movement

Question 15

O/E feel sign in Dupuytren’s contracture

Answer 15

Firm nodule adherent to skin

Question 16

O/E look sign in late Dupuytren’s

Answer 16

MCP/PIPJ contracture

Question 17

Differential diagnoses for ? Dupuytren’s contracture

Answer 17

1 stenosing tenosynovitis 2 ulnar nerve palsy 3 trigger finger

Question 18

Differentiate stenosing tenosynovitis from Dupuytren’s contracture (3)

Answer 18

ST: 1 painful 2 assoc. with overuse 3 or trauma

Question 19

Differentiate ulnar nerve palsy from Dupuytren’s contracture (2)

Answer 19

UNP: 1 reduced strength 2 loss of sensation

Question 20

Differentiate trigger finger from Dupuytren’s contracture

Answer 20

TF: nodule present during finger motion

Question 21

Diagnosis of Dupytren’s contracture

Answer 21

Clinical

Question 22

Use of routine bloods in Dupuytren’s contracture

Answer 22

Assess for potential risk factors

Question 23

Management of early Dupuytren’s contracture

Answer 23

1 watchful waiting 2 conservative management

Question 24

Conservative management of Dupuytren’s contracture (2)

Answer 24

1 injectable collagenase clostrium histolyticum (CCM) 2 hand therapy

Question 25

Indications for surgical management in Dupuytren’s contracture (4)

Answer 25

1 functional impairment 2 MCPJ contracture >30 3 PIPJ contracture 4 rapid progression

Question 26

Surgical intervention option in Dupuytren’s contracture

Answer 26

Fasciectomy

Question 27

Anaesthetic options in fasciectomy

Answer 27

General/local

Question 28

Usual approaches to fasciectomy (3)

Answer 28

1 regional 2 segmental 3 dermofasciectomy

Question 29

Indication for closed fasciotomy in Dupuytren’s contracture

Answer 29

co-morbid pts unsuitable for major surgery

Question 30

When finger amputation used to treat Dupuytren’s contracture

Answer 30

1 delayed presentation 2 with failure of initial management

Question 31

PO recurrence rate in Dupuytren’s contracture

Answer 31

Up to 66%

Question 32

Compare injectable CCM with fasciectomy for EARLY stage Dupuytren’s contracture

Answer 32

1 similar sucess rate 2 higher recurrence rate

Question 33

What is Hueston’s test (2)

Answer 33

1 pt asked to lay palm flat on tabletop 2 +ve if unable