Dupuytren’s Contracture

Definition/diagnostic criteria Dupuytren’s contracture is a hand condition where fibrous tissue forms nodules and cords in the palm, leading to progressive flexion deformity of the fingers, primarily the fourth and fifth digits. It is characterised by thickening of the palmar fascia. The condition is diagnosed based on clinical presentation and physical examination, focusing on the presence of palpable nodules and the inability to fully extend the affected fingers.

Epidemiology This condition predominantly affects Northern Europeans and is more common in men than in women, typically presenting in middle age or later. The prevalence in the UK varies but increases with age, affecting about 20-30% of individuals over 60 years of age. Genetic predisposition is a significant factor, with a familial tendency observed in a considerable number of cases.

Diagnosis
Clinical features: Dupuytren’s contracture typically presents with the gradual development of firm nodules in the palm, often in line with the ring or little finger. As the disease progresses, these nodules may develop into thick cords, leading to flexion contractures of the fingers. Patients usually report difficulty in hand function, especially in activities requiring a flat hand.

Investigations: Diagnosis is primarily clinical. Imaging or biopsy is not routinely required unless atypical features are present or there is diagnostic uncertainty. Typical abnormalities include thickened palmar fascia and flexion deformities of the fingers on examination, without involvement of the joints themselves.

Treatment Treatment depends on the severity and progression of the disease. In mild cases, observation and non-operative management, such as physiotherapy, may be sufficient. For more advanced cases, options include:

• Needle fasciotomy: A minimally invasive procedure to divide the contracture cords.
• Surgical fasciectomy: Involves the removal of the affected fascia.

The choice of treatment should be based on the severity of the contracture, the number of fingers involved, patient preference and the presence of comorbidities.

Prognosis The condition is generally progressive and can lead to significant disability if left untreated. However, the rate of progression is variable. Treatment, especially when initiated in the moderate stages of the disease, can significantly improve hand function and quality of life. Recurrence after treatment is common, with rates varying depending on the treatment modality.