Dupuytren’s contracture is the shortening or hardening of the palmar fascia within the hand, leading to deformity or rigidity of the joints. It’s described as a “fixed flexion deformity”. It commonly occurs in the fourth and fifth digits of the hand. It usually presents as a firm nodule (or multiple nodules) on the palm of the hand. Nodule formation can also occur, although this is usually painless unless there is tenosynovitis.
Grading of the disease:
- Grade 1: presents as a thickened nodule and a band in the palmar aponeurosis. This band may progress to skin tethering, puckering or pitting.
- Grade 2: peritendinous band and extension of finger is limited
- Grade 3: flexion contracture
Risk factors can include diabetes, alcohol abuse, HIV, epilepsy, trauma, vibratory exposure and smoking.
The presentation of Dupuytren’s Contracture includes: decreased range of motion, loss of dexterity and knot or thickening of the palmar surface (this is progressive over many years). Patients may complain of getting their hand “caught” when trying to place it in their pocket. Bilateral involvement is common.
Grade 1 disease can initially be managed expectantly, but injecting the nodule with a steroid can be helpful. Physiotherapy can also be beneficial in the early stages.
If conservative management fails, surgical management could be an option. Surgery is recommended if function is impaired, the contracture is progressing or severe deformity is disabling. Referral to surgeon is indicated if the MCP joint contracture reaches 30 degrees, or if the PIP joint contracture occurs at any degree.