Dupuytrens Contracture

Question 1

What is DC

Answer 1

contraction of the longitudinal palmar fascia.

Question 2

How does DC start.

Answer 2

Painless nodules which progresses to:
fibrous cords and flexion contractures develop at the MCP and interphalangeal joints, which can severely limiting digital movement

Question 3

Which digits does DC Normally affect

Answer 3

Ulnar digits

• little and ring finger

Question 4

What is the pathophysiology of DC

Answer 4

fibroplastic hyperplasia and altered collagen matrix of the palmar fascia. This compositional change leads to a thickening and contraction of the palmar fascia.

Question 5

What is the progression of DC

Answer 5

Initial pitting and thickening of palmar skin

Firm painless nodule begins to form

Cord development

Contraction of the cord => progressive flexion deformity

Question 6

What are the risk factors for DC

Answer 6

Smoking

Alcoholic liver cirrhosis

DM

Occupation exposure

Question 7

what are the clinical features of DC

Answer 7

range from reduced range of motion and nodular deformity through to a complete loss of movement as they can present in any stage of DC

Question 8

In what percentage of cases is the condition bilateral

Answer 8

45%

Question 9

What is the Huestons test

Answer 9

if the patient is unable to lay their palm flat on a tabletop, this is a positive test.

Question 10

What are the differential diagnoses

Answer 10

stenosing tenosynovitis (often painful and associated with overuse or trauma),

ulnar nerve palsy (associated with reduced movement/strength and loss of sensation),

or trigger finger (nodule present associated with finger motion).

Question 11

What are the investigations that need to be carried out

Answer 11

Clinical diagnosis mainly however ideally pt needs

Routine bloods

LFTs

Random glucose

HbA1c

These are to check for any risk factors that would back up the clinical judgement

Question 12

How do you manage DC conservatively

Answer 12

Hand therapy - keep the hand active throughout the day

Injectable collagenase clostridum histolyticum (CCM)

Question 13

When is surgical management indicated in DC

Answer 13

those with functional impairment, MCP joint contracture >30 degrees, any PIP contracture, or rapidly progressive disease.

Question 14

What are the surgical approaches available

Answer 14

Fasciectomy using:

• regional fasciectomy
• segmental fasciectomy
• dermofasciectomy

Finger amputation

Closed fasciotomy