Dupuytren Contracture

For further information, see CMDT Part 41-04: Upper Extremity Musculoskeletal Injuries

• Benign fibrosing disorder of the palmar fascia

• Contracture of one or more fingers can lead to limited hand function

• Cause is unknown

• Occurs primarily in white men older than 50 years. The incidence is higher among alcoholics and patients with chronic systemic disorders (especially cirrhosis)

• Also associated with systemic fibrosing syndrome, which includes

  • Plantar fibromatosis (10% of patients)

  • Peyronie disease (1–2%)

  • Mediastinal and retroperitoneal fibrosis

  • Riedel struma

• Onset may be acute, but slowly progressive chronic disease is more common

• Nodular or cord-like thickening of one or both hands, with the fourth and fifth fingers most commonly affected

• Tightness of the involved digits, with inability to satisfactorily extend the fingers; on occasion, there is tenderness

• The contracture is well tolerated because it exaggerates the normal position of function of the hand, although resulting cosmetic problems may be unappealing

• Clinical findings outlined above

• Corticosteroid injection with a percutaneous needle aponeurotomy has shown some promise

• If the palmar nodule is growing rapidly, injections of triamcinolone or collagenase into the nodule may be of benefit

• Surgical options include open fasciectomy, partial fasciectomy, or percutaneous needle aponeurotomy and are indicated in patients with significant flexion contractures

• Splinting post surgery is beneficial

• Compared to placebo, tamoxifen therapy produced moderate evidence of improvement before or after a fasciectomy