Dupuytren’s contracture is a condition of painless thickening of the tissues in the palm of the hand and fingers. The condition causes contractures, or tightening, of the tissues in the hand causing the fingers to become bent down and the function of the hand is impaired.
The fingers curl up and the patient is unable to straighten them. It is more common in males older than 40 years old and of European decent. It usually affects the ring and little finger.
Risk factors for developing Dupuytren’s contracture are alcoholism, epilepsy, diabetes and liver disease. In some patients it is a hereditary condition.
Symptoms include the inability to straighten the fingers, a cord-link band in the palm, and a deformity that develops slowly (it rarely affects the distal interphalangeal joint. It occurs bilaterally in 50% of the patients.
Tests and Diagnosis
The tabletop test is a simple maneuver that can determine if there is a contracture of the hand. By laying the hand palm down on a tabletop while the patient attempts to flatten the hand. Being able to flatten the hand means that no contracture is present.
Treatment for Dupuytren’s contracture begins conservatively with splinting, followed by an injection (if necessary). Surgery may also be done, which can be needling. The surgeon will cut of excise the cord. The indication for surgery occurs when the MP joint is in 20-30 degrees of flexion contracture or any degree of PIP flexion contracture.
The disease is aggressive and may occur. The patients that will have a poor prognosis are young patients, patients with a bilateral injury, patients who have developed it based on heredity, and it the radial digits are involved.
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