Dupuytren's Contracture Flashcards
What is Dupuytren’s contracture?
Common condition with contraction of the longitudinal palmar fascia
Pathophysiology
Start as painless nodules -> fibrous cords -> flexion contractures
Fibroblastic hyperplasia + altered collagen matrix of palmar fascia.
This leads to thickening and contraction of palmar fascia.
MCPJ and IPJs are affected
This can severely limiting digital movement and reduce QOL
Epidemiology
6x more common in men
40-60yo
Most commonly ring and little finger
Explain the progression of disease.
Initial pitting and thickening of the palmar skin + underlying subcut tissue + loss of mobility of overlying skin.
Painless nodule fixed to skin and deep fascia
Cord development resembling tendon.
Contraction pulling on MCPJ and PIPJ.
Risk factors
Smoking
Alcoholic liver cirrhosis
DM
Occupation exposures by use of vibration tools or heavy manual work.
Clinical features
Depends on stage of progression.
Reduced range of motion to nodular deformity to complete loss of movement
Most commonly ring and little finger.
In 45% the condition is bilateral
Examination findings
Thickened band or firm nodule adherent to skin
Skin blanching may occur on active extension
Contracture
What specific test is done?
Hueston’s test
Explain Hueston’s test
If patient is unable to lay their palm flat on a tabletop -> +ve
Dx
Stenosing tenosynovitis (often painful and. associated with trauma)
Ulnar nerve palsy (reduced movement + strength and loss of sensation)
Trigger finger (nodule present associated with finger motion)
Ix
Diagnosis is clinical
You might want to do routine bloods, LFTs and random glucose/HbA1c to assess Risk factors.
USS can be used to apply intralesional injections
What does management depend on?
Stage of presentation and severity of disease.
Early presentation with no functional disability can be monitored and treated conservatively.
Conservative management
Hand therapy by keeping hand active with multiple stretching exercises throughout the day.
Injectable collagenase clostridum histolyticum (CCM) can be used in early disease
Indications for surgical management
Functional impairment
MCPJ contracture >30 degrees
PIP contracture
Rapidly progressive disease
What interventions are used?
Fasciectomy (most common)
Finger amputation (very very uncommon)
Types of fasciectomy that can be done.
Regional fasciectomy (entire cord is removed, most common)
Segmental fasciectomy (only short segment removed)
Dermofasciectomy (both cord and overlying skin removed -> skin graft to follow)
Closed fasciotomy (less commonly used) Might be done in outpatient setting under local anaesthetic so suitable in co-morbid patients.
