Dupuytrens disease

Question 1

What is Dupuytrens disease?

Answer 1

Thickening and scarring of connective tissue under the skin in the palm, fingers
Most commonly RF, LF

Question 2

Prevalence

Answer 2

Higher in males
Usually 40-60 years old
Genetic involvement

Question 3

What is affected?

Answer 3

Longitudinal pretendinous bands

Vertical extensions of palmar aponeurosis

Question 4

Diagnosis test

Answer 4

Huestone’s table top test

Question 5

Composite contracture

Answer 5

MP and PIPJ involved, only one joint can extend while the other is flexed
Cannot extend both at the same time

Question 6

Fixed contractures

Answer 6

Both cannot be extended beyond a certain degree

Question 7

Stages

Answer 7

1. 0-45 degs
2. 45-90 degs
3. 90-135 degs
4. 135-180 degs

Question 8

Surgical indications

Answer 8

Rapid progression
Functional disability
Severe flexion contracture
Informed consent
Good general health
Physio compliance

Question 9

Fasciectomy

Answer 9

Remove diseased fascia
Partial- remove only diseased
Total- remove diseased and normal fascia
Dermo- excision of skin with fascia, skin graft
Segmental- remove segments of cords

Question 10

Possible complications of surgery

Answer 10

Oedema
Infection
Haematoma
Nerve or artery damage
Tendon adhesions
CRPS
Recurrence

Question 11

Splinting post op

Answer 11

Maintain or improve extension range achieved in surgery

Question 12

Physiotherapy

Answer 12

Active flexion+ext of all digits
Isolated passive flex/ext of MCP, PIP, DIPJ
Passive stretches into composite flexion
Scar management