Dupuytren Contracture

The earliest manifestation is usually a tender nodule in the palm, most often near the little or ring finger; it gradually becomes painless. Next, a superficial cord forms and contracts and ultimately flexes the metacarpophalangeal (MCP) joints and interphalangeal joints of the fingers. The hand eventually becomes arched. The disease is occasionally associated with fibrous thickening of the dorsum of the proximal interphalangeal (PIP) joints (Garrod pads), Peyronie disease Peyronie Disease Peyronie disease is fibrosis of the cavernous sheaths leading to contracture of the investing fascia of the corpora, resulting in a deviated and sometimes painful erection. Peyronie disease... read more (penile fibromatosis) in about 7 to 10% of patients, and rarely nodules on the plantar surface of the feet (plantar fibromatosis).

Other types of flexion deformities of the fingers can also occur in diabetes, locked trigger fingers, an ulnar claw hand, systemic sclerosis, and chronic reflex sympathetic dystrophy, which need to be differentiated.

Injection of a corticosteroid suspension into the nodule may relieve local tenderness if begun before contractures develop. However, this tenderness is self-limiting and often resolves with no intervention.

If the hand cannot be placed flat on a table or, especially, when significant contracture develops at the proximal interphalangeal (PIP) joints, surgery is usually indicated. Surgical options include percutaneous needle fasciotomy, temporary application of a dynamic external fixator for PIP joint contractures, and open palmar/digital fasciectomy. For severe disease with multiple finger involvement, open surgery with excision of the diseased fascia is the best treatment; excision must be meticulous because the tissue surrounds neurovascular bundles and tendons. Incomplete excision or new disease results in recurrent contracture, especially in patients who are young at disease onset or who have a family history, Garrod pads, Peyronie disease, or plantar foot involvement.

Injectable collagenase may reverse some contractures (1 Treatment references Dupuytren contracture is progressive contracture of the palmar fascial bands, causing flexion deformities of the fingers. Treatment is with corticosteroid injection, surgery, or injections of... read more , 2 Treatment references Dupuytren contracture is progressive contracture of the palmar fascial bands, causing flexion deformities of the fingers. Treatment is with corticosteroid injection, surgery, or injections of... read more ), particularly those at the MCP joint. Collagenase injections and surgical fasciectomy result in similar improvements at the MCP joint, but injections lead to more rapid recovery with fewer early complications (3 Treatment references Dupuytren contracture is progressive contracture of the palmar fascial bands, causing flexion deformities of the fingers. Treatment is with corticosteroid injection, surgery, or injections of... read more ). However, when comparing midterm results (2 to 5 years after treatment) of collagenase injection, percutaneous needle fasciotomy, and surgical fasciectomy, injections had the highest recurrence rate requiring reintervention, whereas surgery had the lowest rate of recurrent contractures.