Dupuytren's Contracture

Question 1

define

Answer 1

proliferative connective tissue disorder where the palmar fascia undergoes hyperplasia forming nodules and cords progressing to contractures at the MCP and PIP joints, leading to FFD

Question 2

what is there proliferation of?

Answer 2

myofibroblast cells

production of abnormal collagen (type 3 rather than 1)

Question 3

what is this associated with?

Answer 3

genetics
DM
alcohol/cirrhosis
smoking
phenytoin therapy
epilepsy/antiepileptic medication
trauma
Lederhosen and Peyronies

Question 4

which gender is this more common in?

Answer 4

male

Question 5

presentation

Answer 5

usually starts as palmar pit/nodule
painless with gradual progression of flexion
unable to straighten

Question 6

diagnosis

Answer 6

on examination feel cords, MCP/PIP involvement

table top test (unable to flatten)

Question 7

management

Answer 7

conservative= stretches and activity modification
Surgery= segmental fasciectomy, fasciectomy, dermo-fasciectomy or amputation
newer treatments include collagenase injection and percutaneous needle fasciotomy