Dupuytren contracture
Dupuytren contracture is fibroblastic proliferation and collagen deposition in the palmar fascia that produces painless nodules, then palmar cords, then a fixed flexion contracture of the ring and little fingers, typically after the fifth decade in White men. It is a clinical diagnosis on palpation and inspection, treated with intralesional collagenase or surgical fasciectomy once a joint contracture limits extension.
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What this article covers
- Overview
What it is: Dupuytren contracture is a fibroproliferative disorder of the palmar fascia that progresses from a painless palmar nodule to a palpable cord to a fixed flexion contracture of the fingers.
- Epidemiology
Age and sex: onset is typically after the fifth decade of life.
- Risk factors
Alcohol use disorder and cirrhosis: Dupuytren contractures are a recognized physical exam finding in alcohol-associated cirrhosis, alongside jaundice, spider angiomas, palmar erythema, gynecomastia…
- Pathophysiology
Step one, fibroblastic proliferation: an abnormal proliferation of fibroblasts develops within the palmar fascia.
- Clinical features
Hallmark, earliest finding: a painless nodule in the palm is the first manifestation.
- Differential diagnosis
Trigger finger: digital flexor tendon inflammation and stenosis causes catching or locking of a finger with pain, distinguished from Dupuytren contracture by the presence of pain and a palpable catch…
- Diagnosis
How the diagnosis is made: Dupuytren contracture is a clinical diagnosis made on inspection and palpation, confirmed by characteristic palmar nodules or cords (depending on clinical stage) together…
- Management
First, observe early, non-contracted disease: a painless nodule or cord without a joint contracture that limits function does not require intervention.
- Complications
High recurrence rate: recurrence is common even after surgical correction, regardless of whether fasciotomy, fasciectomy, or needle aponeurotomy was used.
- Prognosis
Early, non-contracted disease is not disabling: a palmar nodule without a fixed contracture does not itself impair hand function and can be observed.
- Prevention
Address the strongest modifiable association: in a patient with alcohol use disorder or cirrhosis, treating the underlying alcohol use disorder addresses the condition most strongly associated with…
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