++
+++
Essentials of Diagnosis
++
+++
General Considerations
++
Cause is unknown
Occurs primarily in White men older than 50 years; incidence is higher among alcoholics and patients with chronic systemic disorders (especially cirrhosis)
Also associated with systemic fibrosing syndrome, which includes
++
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
++
++
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 patients with more severe flexion contractures include
++
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 PIP joints than for MCP 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 to placebo, tamoxifen therapy produced moderate evidence of improvement before or after a fasciectomy
++
+
Boe
C
et al. Dupuytren contractures: an update of recent literature. J Hand Surg Am. 2021;46:896.
[PubMed: 34452797]
+
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]
+
Leafblad
ND
et al. Outcomes and direct costs of needle aponeurotomy, collagenase injection, ...