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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)
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Dupuytren’s contracture

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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Try a related OSCE station

  1. Chronic liver disease abdominal exam
  2. Find more here

Image reference: Dupuytren’s contracture: 2010 James Heilman, MD, Creative Commons Attribution-Share Alike 3.0 Unported license

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