Dupuytren's Contracture

Question 1

Causes

Answer 1

• Genetic mutation of enzyme that lays down collagen

- Can be triggered by physical trauma

Question 2

Description

Answer 2

• Thickening of longitudinal fibers of palmar fascia
• Usually starts as nodule at A1 pulley
• Knots/nodules & cords are characteristic features

Question 3

Distinguishing from trigger finger

Answer 3

• Both often have tenderness at MP joint and nodule at A1 pulley
• Dupuytren’s is disease of shallow tissue, not a mechanical friction problem
• Not reversible without surgery

Question 4

Conservative treatment

Answer 4

• Provide education
• Teach hand-flattening stretch on table
• Night splints
• Joint protection strategies
• Adaptive equipment (built-up handles, etc.)

Question 5

Medical treatment

Answer 5

• Xiaflex injections: collagenase clostrodium histolyticum (made from gangrene bacteria which attacks thickened fascia)
• Needle aponeurotomy (surgeon uses need to free fascia)
• Surgery to remove diseased fascia