Dupuytren’s Contracture: The Permanently Flexed Fingers, and How to Manage Them
Dupuytren’s contracture, a fibroproliferative disease of aponeurosis of palm, presents as thickening of palmer skin along with formation of nodules adherent to deep fascia and skin. It arises secondary to proliferation of myofibroblasts; these increased myofibroblasts subsequently replace collage type I to collagen type III.
Individuals with Dupuytren’s contracture are typically males, age ranging from 40 to 80 years, along with history of alcoholism, epilepsy, manual labor, trauma, and diabetes. There is a genetic etiology of Dupuytren’s contracture, which causes more aggressive, early presentation.
All the digits can be affected, however, most common are ring and middle fingers. Typically involved joint are metacarpophalangeal and proximal interphalangeal joints.
Diagnosis is based on clinical examination along with key findings in history indicating presence of risk factors such as chronic alcoholism or smoking etcetera. Hueston’s table to test, if positive, is indicative of treatment. The angle of contracture at metacarpophalangeal greater than 30 degrees also indicates need for treatment.
The aim of management of Dupuytren’s contracture is to eliminate deformity and to prevent associated neurovascular injury. Treatment may be operative and non-operative, depending on severity and patient’s condition.
Non-operative options include physiotherapy, pharmacological therapy such as hyperbaric oxygen, vitamin E and steroids, radiotherapy, and collagenase derived from Clostridium histolyticum.
Operative management may include techniques like needle fasciotomy, limited fasciotomy, and dermofasciectomy.
Unfortunately, these is no definitive treatment of Dupuytren’s contracture, hence, there is always a chance of recurrence.
Dupuytren’s Contracture – Current Concepts
Image via https://www.londonupperlimbsurgery.co.uk/dupuytrens-disease/