dupuytrens contracture Flashcards
what is DC?
condition involving contraction of the longitudinal palmar fascia
development at MCP and iP joints can limit digital movement and reduce QoL
what is the pathophysiology of DC?
involves a fibroplastic hyperplasia and altered collagen matrix of the palmar fascia.
This compositional change leads to a thickening and contraction of the palmar fascia.
what are the risk factors for DC?
- smoking
- alcoholic liver cirrhosis
- DM
- occupational exposures e.g vibration tools
what are the clinical features of DC?
varied dependent on stage of progression
- reduced ROM
- nodular deformity
- ring and little finger are most commonly involved
- skin blanching may occur
what are your differentials?
- stenosing tenosynovitis
- ulnar nerve palsy
- trigger finger
what investigations can be done into DC?
clinical diagnosis but do routine bloods including LFTs and random glucose/HbA1C to asses for associated risk factors
how is DC managed conservatively?
early stage treated this way
- hand therapy to keep hand active
- injectable collagenase clostridum histolyticum (CCM) in early disease
how is DC managed surgically?
for progressed disease
- fasciectomy under anaesthetic
- in very severe cases that present late, finger amputation, but this is rare
when is surgical management indicated?
- functional impairment
- MCP joint contracture >30 degrees
- PIP contracture
- rapidly progressive disease
