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

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