Dupuytren's contracture 4.73/5 (15)

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Dupuytren's contracture
Dupuytren's contracture (hook finger). Illustration: Frank C. Müller (https://creativecommons.org/licenses/by-sa / 4.0)

Definition

Dupuytren's contracture is due to hard connective tissue (fibrosis) contracting over tendons in parts of the palm. The condition is also popularly called palmar fibromatosis or "hook finger". A painless, knotted thickening just under the skin over the flexor tendon of the ring finger or little finger is typical. Gradually, the connective tissue thickens and contracts so that the fingers become crooked. Dupuytren's contracture is limited to one or both hands (localized) and not one systemic connective tissue diseases. The condition is related to similar thickenings under the sole of the foot, in the form of the much rarer one Cerebrovascular disease and Garrod's pillows over finger joints (PIP joints).

Occurrence of Dupuytren's contracture

Dupuytren's contracture is somewhat more common in men than women, but occurs in both sexes. Most are over 50 years of age. Among men over the age of 65, Dupuytren's contracture can occur in as much as 30% of the population. Conditions are more common among northern Europeans than in many other parts of the world. Diabetes mellitus also predisposes.  

Disease Cause

It is not known why someone gets the condition, but similarly in immediate family and diabetes mellitus the incidence increases. Once the disease has begun, too much gradual connective tissue forms over tendons in the palm of the hand. One has shown that the connective tissue (palmar fascia) normally consists of collagen type I, but with Dupuytren's contracture, collagen type III develops, which is thicker.

Symptoms of Dupuytren's contracture

Dupuytren's contracture begins as a hard, non-painful lump in the palm, most often within the ring finger (finger 4). The thickening is associated with the skin and is best recognized when the fingers are stretched. It gradually extends outwards towards the fingers. At the same time, the stretching ability of the fingers is reduced. Ring finger (finger 4) and little finger (finger 5) are most commonly attacked.

Dupuytren's contracture
Dupuytren's contracture with 90 degree contracture in the little finger. Howard JC, Varallo VM, Ross DC, Roth JH, Faber KJ, Alman B, Gan BS - BMC Musculoskeletal Disord (2003). Open-in

Investigations at Dupuytren's contracture

Medical history is most often without special characteristics, except that Scandinavians, men over the age of 50 and people with diabetes are most at risk. 

Clinical feels painless, slightly knotted thickening over flexor tendons to ring finger (finger 4), possibly also little finger (finger 5). In the "table top test", the palm is pressed against the table top and at the same time one tries to stretch the fingers up from the table. The attacked finger cannot be stretched or can prevent the palm from being pressed all the way down. 

Blood and urine samples expected to be normal. 

Imaging is usually not necessary to get the diagnosis, but by ultrasound examination one will be able to detect thickened connective tissue. 

Diagnosis

The medical history and clinical examination are usually sufficient

Similar conditions, differential diagnosis by Dupuytren's contracture

By d: Diabetic cheyarthropathy (joint stiffness) / diabetic hand. Volkmann's ischemic contracture occurs after injury to the arm. Rheumatic inflammation along the flexor tendons (stenosing flexortenosynovitis, ganglion cyst, and soft tissue tumors can also cause thickening of the palms). 

Treatment of Dupuytren's contracture

With small changes, one often chooses to observe whether the condition increases or is stable, which the general practitioner / GP can be helpful with. It is possible strains can help in the early stages of the disease to maintain tensile strength. Many are referred for treatment if the table top test is positive, contractures in the MCP joint have reached 30 degrees or the PIP joint 15-20 degrees.

The treatment indication is assessed by a hand surgeon or orthopedist. Treatment may include so-called needle aponeurotomy, collagenase injection and / or surgical resection / fascietomy (reference: Hovius SER, 2018). Surgery is often chosen if there is a lack of 30-40 degrees or more at full stretch in the basic joint (MCP) or over 20 degrees in the intermediate joint (PIP).

Prognosis

Dupuytren's contracture does not damage internal organs and does not affect longevity. The condition is not painful, but hand function is gradually reduced in many people. The symptoms rarely go away on their own, but in about 50% of cases the development stops. If one or more fingers are severely attacked, "hook fingers" can inhibit, among other things, dressing and undressing. After any treatment, it is not uncommon for relapses, but not necessarily with equally large changes.

Literature


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