Dupuytren’s contracture

Progressive palmar fascia thickening that results in tethering, fixed finger flexion and skin puckering.

Associations

• Family history
• Liver disease/alcohol
• Antiepileptic drugs
• Diabetes mellitus
• As a feature of other collagen tissue disorders (see questions below)

Clinical features

• Fixed flexion of fingers (especially little and ring fingers)
• Thickened palmar fascia
• Positive table top test (functional test)

Management

Non-surgical

• Conservative management if not limiting function
• Splinting and physiotherapy 
• Corticosteroid injections
• Collagenase injections (collagenase enzymes break down collagen)

Minimally invasive

• Needle aponeurotomy (parts of contracted cord weakened by needle manipulation)
• Percutaneous fasciotomy (parts of contracted cord weakened by multiple incisions)
• Segmental aponeurotomy (segments of contracted cord removed by small incisions)

Surgical (open)

• Partial fasciectomy (diseased fascia removed)
• Dermofasciectomy (skin also removed and replaced with skin graft) – lowest recurrence rate

Complications of surgical intervention

• Recurrence (50%)
• Bleeding
• Scarring
• Infection
• Neurovascular complications

Other collagen disorders are associated with Dupuytren’s contracture. What are their characteristic features?

Peyronie’s disease

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Ledderhose disease

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Garrod’s disease

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Picture references

Dupuytren’s contracture: 2010 James Heilman, MD, Creative Commons Attribution-Share Alike 3.0 Unported license (https://creativecommons.org/licenses/by-sa/3.0/deed.en). Sourced from: https://commons.wikimedia.org/wiki/File:Dupuytren%27s2010.JPG