The FP diagnosed Dupuytren contracture (also known as palmar fibromatosis, morbus Dupuytren), a flexion contracture of one or more fingers. Patients develop a progressive thickening of the palmar fascia that which causes the fingers to bend in toward the palm, limiting extension. Dupuytren contracture is an autosomal dominant disease with incomplete penetrance. The diagnosis is clinical and palpable nodules and/or cords in the palm are considered diagnostic.
Dupuytren contracture is more prevalent among whites, particularly Northern Europeans, and the incidence increases with age. Dupuytren contracture is more common in men than in women (approximately 6:1). People who use tobacco and alcohol, or who have diabetes mellitus or epilepsy, also have a higher incidence of the disease.
Treatment has historically been surgical, but a nonsurgical treatment with collagenase is now available.
Surgical correction is considered when there is at least 30 degrees of contracture at the metacarpophalangeal joint. A fasciotomy decreases the degree of flexion deformity and results in modest improvements in hand function. An intralesional injection of corticosteroids, however, is only mildly successful and may place the patient at risk for tendon rupture.
Studies indicate that improvements in function are correlated with changes at the proximal interphalangeal joint. The recurrence rate increases with time and is related to the amount of fascia that is removed during surgery.
Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Delzell J, Chumley H. Dupuytren disease. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:625-628.
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