Dupuytren Disease

Question 1

What is it?

Answer 1

> Hypertrophy and contracture of palmar aponeurosis (superficial palmar fascia)
Typically bilateral flexion contracture of MCP/PIP/DIP + loss of function (most common in ring and little fingers)
Slow - progressing over years

Question 2

Cause

Answer 2

> Fibroblast proliferation
Collagen deposits
Contracture of fascia

Question 3

Presentation

Answer 3

> Initial thickening of skin
bands of fibrotic tissue form in palmar area
affected fingers are pulled into flexion

Question 4

Risk Factors

Answer 4

> North European descent
> Male 
> Increases with age (av. = 60 yrs)
> strong genetic component
> Excess alcohol
> Smoking
> Manual labour 
> Low BMI or body weight 
> Anti-convulsant drugs 

• Associated with:
• Diabetes
• epilepsy
• HIV
• adhesive capsulitis
• Cancer

Question 5

Management

Answer 5

> Surgery (main treatment)

• fasciotomy (early stage - contracted cord = cut but not removed)
• fasciectomy (diseased fascia = cut = removed)
• Dermo fasciectomy (severe + recurrent = removes overlying skin and fat as well as fascia so graft is needed)
• Amputation of digits = last resort

> Physio (post op mainly)

• Splinting
• Exercises (passive stretching/ active/ function)
• Education + advice
• oedema and scar management

*Recurrence = v.common