DUPUYTREN’S CONTRACTURE

DUPUYTREN’S CONTRACTURE


DUPUYTREN’S CONTRACTURE (Contracture of the palmar aponeurosis)

  • Condition characterised by a flexion deformity of one or more fingers.
  • Due to a thickening and shortening of the palmar aponeurosis.

Structure of the Palmar Aponeurosis

  • The palmar aponeurosis (fascia) is formed by a thick condensation of the deep fascia.
  • It is triangular in shape and attached:
  1. Proximally—to the flexor retinaculum and palmaris longus tendon
  2. Laterally—covers the thenar muscles of the hand.
  3. Medially—covers the hypothenar muscles.
  4. Distally—divides into four major slips
Etiology

  • It shows a genetic predisposition
  • Diabetes, epilepsy and alcohol 
Clinical Features

  1. Thickened fibrous bands felt over the ulnar side of the palm.
  2. Thickening of plantar fascia or that of the penile fascia (Peyronie’s disease).
  3. Tenderness over the involved area at the base of the digits.
  4. Flexion deformity at the MCP and PIP joints of involved fingers. 

4 Stages of Dupuytren’s Contracture:

  • Stage 1: Your finger will be bent 6º-45º.
  • Stage 2: Your finger will be bent 46º-90º.
  • Stage 3: Your finger will be bent 91º-135º.
  • Stage 4: Your finger will be bent greater than 135º.

Treatment
  • Minor deformities are treated nonoperatively. 
  • Patients are advised to avoid the predisposing factors, e.g. alcohol intake.
  • Cases where the contracture is severe and painful, surgical excision of the contracted tissue is advised.

Exam Important

DUPUYTREN’S CONTRACTURE (Contracture of the palmar aponeurosis)

  • Condition characterised by a flexion deformity of one or more fingers.
  • Due to a thickening and shortening of the palmar aponeurosis.
Etiology

  • It shows a genetic predisposition
  • Diabetes, epilepsy and alcohol 
Clinical Features

  1. Thickened fibrous bands felt over the ulnar side of the palm.
  2. Thickening of plantar fascia or that of the penile fascia (Peyronie’s disease).
  3. Tenderness over the involved area at the base of the digits.
  4. Flexion deformity at the MCP and PIP joints of involved fingers.
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