Dupuytrens contracture
📖 Dupuytren’s contracture – famously operated on in Margaret Thatcher while Prime Minister.
Historically treated by a “whack with the family Bible” to rupture cords.
Today, it is recognised as a fibroproliferative disorder of the palmar fascia causing progressive flexion deformity.
📖 About
- A chronic hand condition impairing function and grip.
- Characterised by progressive palmar fascia fibrosis → nodules, cords, contractures.
- Primarily affects the ring and little fingers; often bilateral (~50%).
🧬 Aetiology / Pathophysiology
- Exact cause unknown.
- Driven by abnormal myofibroblast proliferation and excess type III collagen deposition.
- Starts as a palmar nodule → fibrous cord → MCP/PIP joint contracture.
🔗 Possible Associations
- Frozen shoulder (adhesive capsulitis).
- Ledderhose disease (plantar fibromatosis).
- Peyronie’s disease (penile fibromatosis).
⚠️ Risk Factors
- Demographics: Men (6:1), peak age 50–70, Northern European ancestry (“Viking’s disease”).
- Lifestyle: Smoking, alcohol excess (esp. cirrhosis), vibration tool use.
- Medical: Diabetes mellitus, epilepsy (long-term anticonvulsants).
🖐️ Clinical Features
- Painless palmar nodules → fibrous cords → progressive flexion deformity.
- Most commonly ring & little finger.
- Often bilateral in ~50% of patients.
- Hueston’s tabletop test: inability to lay palm flat = positive.
- May impair hand function, dexterity, grip, and QOL.
🔎 Investigations
- Clinical diagnosis – no test required.
- Bloods (FBC, U&E, LFTs, glucose, ESR) → check for associations, comorbidities.
⚕️ Management
- Mild / Early: Observation, hand-stretching exercises.
- Injections: Collagenase (Clostridium histolyticum) can weaken cords for manipulation.
- Minimally invasive: Percutaneous needle fasciotomy – useful in frail/unfit patients, higher recurrence.
- Surgical: Fasciectomy (partial/total excision of diseased fascia). Consider if functional impairment or contracture >30°.
Performed under local or general anaesthetic. Mainstay of treatment.
- Rare: Finger amputation (severe recurrent cases with poor function).
💡 Key Exam Pearl: Dupuytren’s = painless palmar nodules → cords → flexion deformity.
Think “Viking’s disease”: men, 50+, ring & little finger.
Always mention Hueston’s test and its associations (Peyronie’s, Ledderhose, frozen shoulder).
📚 References
