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:
- Proximally—to the flexor retinaculum and palmaris longus tendon
- Laterally—covers the thenar muscles of the hand.
- Medially—covers the hypothenar muscles.
- Distally—divides into four major slips
Etiology
- It shows a genetic predisposition
- Diabetes, epilepsy and alcohol
Clinical Features
- Thickened fibrous bands felt over the ulnar side of the palm.
- Thickening of plantar fascia or that of the penile fascia (Peyronie’s disease).
- Tenderness over the involved area at the base of the digits.
- 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
- Thickened fibrous bands felt over the ulnar side of the palm.
- Thickening of plantar fascia or that of the penile fascia (Peyronie’s disease).
- Tenderness over the involved area at the base of the digits.
- Flexion deformity at the MCP and PIP joints of involved fingers.
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