Dupuytrens contracture

Question 1

What is Duputrens contracture?

Answer 1

Common condition involving contraction of the longitudinal palmar fascia

Question 2

What happens to the fascia in Dupuytrens contracture?

Answer 2

Fibroplastic hyperplasia and altered collagen matrix of the palmar fascia, this leads to thickening and contraction of the palmar fascia

Question 3

How does disease progress in Dupuytres contracture?

Answer 3

1. Pitting and thickening of palmar skin and underlying subcutaneous tissue, with loss of mobility in overlying skin 2. firm painless nodules, fixed to skin and deep fascia that gets bigger 3. a cord then develops that looks like a tendon that contracts over months to years 4. contraction of the cord pulls on the MCP and PIP joints causing progressive flexion deformity in the fingers

Question 4

What are the risk factors for Dupuytrens contracture?

Answer 4

Smoking, alcoholic liver cirrhosis, Diabetes mellitus, occupational exposure, idiopathic

Question 5

What are the symptoms fo Dupuytrens contracture?

Answer 5

reduced range of motion and nodular deformity through to compete loss of movement, ring and little finger most commonly involved

Question 6

What are the signs on examination of dupuytrens contracture?

Answer 6

thickened band or firm nodule adherent to the skin may be palpable, skin blanching may occur on active extension of the affected digits, MCP or PIP joints may be affected

Question 7

What is Huestons test?

Answer 7

specific test where if the patent is unable to lay there palm flat on a table top, this is a positive test

Question 8

What are the differential diagnosis for Dupuytrens contracture?

Answer 8

Stensoing tenosynovitis, ulnar nerve palsy, trigger finger

Question 9

How is Duputrens contracture diagnosed?

Answer 9

Usually clinically, no imaging is needed but can use ultrasound to guide with injections

Question 10

What is the conservative management for Dupuytrens Contracture?

Answer 10

Hand therapy, injectable collagenase clostridium histolyticum

Question 11

What is the surgical management for Dupuytrens contracture?

Answer 11

excision of diseased fascia, by a fasciectomy

Question 12

Who should have surgical management for Dupuytrens contracture?

Answer 12

Patients with functional impairment, MCP joint contracture greater than 30 degrees, PIP contracture or rapidly progressing disease