Dupuytren’s Contracture

• Progressive condition resulting from fibrosis and contracture of the superficial palmar fascia of the hands due to excessive myofibroblast proliferation.
  • Age-related, usually bilateral and more common in men.
  • Cause is largely unknown but associated with
    • family history
    • trauma/chronic fibration injury
    • excess alcohol
    • planta fibromatosis (equivalent but in the foot)
    • Peyronie’s disease (in men- penile fascia)
    • Smoking increases risk; as does diabetes, hypercolesterolaemia, use of anticonvulsant drugs
• Presentation
  • Unable to extend fingers fully (more commonly ring/little finger affected)
  • Skin puckering and palpable nodules in the palm
  • Usually painless, but can limit hand function
• Treatment
  • Nonsurgical
    • Local injections of collagenase
  • Surgical
    • Fasciotomy
  • Note that stretching/splinting and corticosteroid injections are not recommended