Dupuytren’s contracture is a condition where the fascia of the hand becomes thickened and tight, leading to finger contractures.
A contracture is a shortening of the soft tissues that leads to restricted movement in a joint. In Dupuytren’s contracture, the finger is tightened into a flexed position and cannot fully extend.
Pathophysiology
The palmar fascia of the hand forms a triangle of strong connective tissue on the palm.
In Dupuytren’s contracture, the fascia of the hands becomes thicker and tighter and develops nodules. Cords of dense connective tissue can extend into the fingers, pulling the fingers into flexion and restricting their ability to extend (contracture).
It is unclear why the fascia becomes thicker and tighter. However, it is thought to be an inflammatory process in response to microtrauma.
Risk Factors
- Age
- Family history (autosomal dominant pattern)
- Male
- Manual labour, particularly with vibrating tools
- Diabetes (more with type 1, but also type 2)
- Epilepsy
- Smoking and alcohol
Presentation
The first sign of Dupuytren’s contracture is the development of hard nodules on the palm. There may be skin thickening and pitting. Slowly, the fascia becomes thicker, and the finger is pulled into flexion. It becomes impossible to extend the affected finger fully.
A thick, nodular cord can be palpated from the palm into the affected finger.
The ring finger is most often affected. The index finger is least likely to be affected.
Dupuytren’s contracture can significantly affect the function of the hand. However, patients do not usually experience pain with the condition.
The table-top test is a straightforward test for Dupuytren’s contracture. The patient tries to position their hands flat on a table. If the hand cannot rest completely flat, the test is positive, indicating Dupuytren’s contracture.
Management
The options for Dupuytren’s contracture are essentially to do nothing (conservative management) or to treat it surgically. There are three options for surgical management.
Needle fasciotomy (also known as needle aponeurotomy) involves inserting a needle through the skin to divide and loosen the cord that is causing the contracture.
Limited fasciectomy involves removing the abnormal fascia and cord to release the contracture.
Dermofasciectomy involves removing the abnormal fascia and cord, as well as the associated skin. A skin graft is used to replace the removed skin.
Last updated August 2021
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