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Essentials of Diagnosis
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General Considerations
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Cause is unknown, but there is a genetic disposition
Occurs primarily in White men older than 50 years, particularly in those of Celtic descent
Incidence is higher among patients with alcohol use disorder and chronic systemic disorders (especially cirrhosis)
Also associated with systemic fibrosing syndrome, which includes
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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 may be cosmetically unappealing, but in general it is well tolerated since it exaggerates the normal position of function of the hand
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Common treatment options
Corticosteroid injections
Percutaneous needle aponeurotomy
Collagenase Clostridium histolyticum (CCH) injections
Open fasciectomy
Injections of triamcinolone or collagenase into a rapidly growing palmar nodule may be of benefit
Injection of CCH lyses collagen, thereby disrupting the contracted cords
Surgical options for more severe flexion contractures include
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Splinting after surgery is beneficial
Recurrence and more adverse events are more likely to occur after surgery than with nonoperative treatments
Overall, treatment success is lower for proximal interphalangeal joints than for metacarpophalangeal joints
Fasciectomies are more successful for severe conditions involving multiple fingers, while percutaneous needle aponeurotomy is cost effective and useful for milder cases and for single digit involvement
CCH injections are not currently cost effective due to high reintervention rates, regardless of severity
Some evidence suggests superior clinical outcomes of percutaneous needle aponeurotomy compared with CCH and a higher minor complication rate with CCH
Compared with placebo, tamoxifen therapy produced moderate evidence of improvement before or after a fasciectomy
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Boe
C
et al. Dupuytren contractures: an update of recent literature. J Hand Surg Am. 2021;46:896.
[PubMed: 34452797]
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Hirase
T
et al. Percutaneous needle fasciotomy versus collagenase injection for Dupuytren's contracture: a systematic review of comparative studies. J Hand Microsurg. 2021;13:150.
[PubMed: 34511831]