Dupuytren Contracture
Dupuytren Contracture is a topic covered in the 5-Minute Clinical Consult.
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Basics
Description
- Palmar fibromatosis; caused by progressive fibrous proliferation and tightening of the fascia of the palms, resulting in flexion deformities and loss of function
- Not the same as “trigger finger,” which is caused by thickening of the distal flexor tendon
- Similar change rarely occurs in plantar fascia, usually appearing simultaneously.
- System(s) affected: musculoskeletal
- Dupuytren diathesis is an aggressive form that has ectopic involvement of knuckle pads, plantar fibromatosis (Ledderhose – 10%), and penile fibromatosis (Peyronie – 2%).
- Synonyms: morbus Dupuytren; Dupuytren disease; “Celtic hand;” Viking’s disease; palmar fascial fibromatosis, contracture of palmar fascia
Epidemiology
Prevalence- Increases with age; mean prevalence in Western countries: 12%, 21%, and 29% at ages 55, 65, and 75 years, respectively. Norway: 30% of males >60 years; Spain: 19% of males >60 years
- More common in Caucasians of Scandinavian or Northern European ancestry
- Mean age of onset is 60 years.
Etiology and Pathophysiology
Unknown; possibly oxidative stress, altered wound repair, and/or abnormal immune response. Occurs in three stages:
- Proliferative phase: proliferation of myofibroblasts with nodule development on palmar surface
- Involutional stage: spread along palmar fascia to fingers with cord development
- Residual phase: spread into fingers with cord tightening and contracture formation
- Autosomal dominant with incomplete penetrance:
- Siblings with 3-fold risk
- 68% of male relatives of affected patients develop disease at some time.
- Possible association with human leukocyte antigen alleles
Risk Factors
- Smoking (mean 16 pack-years, odds ratio: 2.8)
- Increasing age
- Male/Caucasian; male > female (range 3.5:1 to 9:1)
- Vibration exposure and manual work—risk doubles if regular (weekly) exposure
- Diabetes mellitus (DM) (increases with duration of DM, usually mild; middle and ring finger involved)
- Epilepsy
- Chronic illness (e.g., pulmonary tuberculosis, liver disease, HIV)
- Hypercholesterolemia
- Excessive alcohol consumption
- Northern European ethnicity
- Family history
- Hand trauma
- Low body weight and body mass index
General Prevention
Avoid risk factors, especially if a strong family history.
Commonly Associated Conditions
- Alcoholism
- Epilepsy (inconstant data)
- DM
- Chronic lung disease
- Occupational hand trauma (vibration)
- Hypercholesterolemia
- Carpal tunnel syndrome
- Peyronie disease
- HIV
- Cancer
- Adhesive capsulitis of shoulder
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Basics
Description
- Palmar fibromatosis; caused by progressive fibrous proliferation and tightening of the fascia of the palms, resulting in flexion deformities and loss of function
- Not the same as “trigger finger,” which is caused by thickening of the distal flexor tendon
- Similar change rarely occurs in plantar fascia, usually appearing simultaneously.
- System(s) affected: musculoskeletal
- Dupuytren diathesis is an aggressive form that has ectopic involvement of knuckle pads, plantar fibromatosis (Ledderhose – 10%), and penile fibromatosis (Peyronie – 2%).
- Synonyms: morbus Dupuytren; Dupuytren disease; “Celtic hand;” Viking’s disease; palmar fascial fibromatosis, contracture of palmar fascia
Epidemiology
Prevalence- Increases with age; mean prevalence in Western countries: 12%, 21%, and 29% at ages 55, 65, and 75 years, respectively. Norway: 30% of males >60 years; Spain: 19% of males >60 years
- More common in Caucasians of Scandinavian or Northern European ancestry
- Mean age of onset is 60 years.
Etiology and Pathophysiology
Unknown; possibly oxidative stress, altered wound repair, and/or abnormal immune response. Occurs in three stages:
- Proliferative phase: proliferation of myofibroblasts with nodule development on palmar surface
- Involutional stage: spread along palmar fascia to fingers with cord development
- Residual phase: spread into fingers with cord tightening and contracture formation
- Autosomal dominant with incomplete penetrance:
- Siblings with 3-fold risk
- 68% of male relatives of affected patients develop disease at some time.
- Possible association with human leukocyte antigen alleles
Risk Factors
- Smoking (mean 16 pack-years, odds ratio: 2.8)
- Increasing age
- Male/Caucasian; male > female (range 3.5:1 to 9:1)
- Vibration exposure and manual work—risk doubles if regular (weekly) exposure
- Diabetes mellitus (DM) (increases with duration of DM, usually mild; middle and ring finger involved)
- Epilepsy
- Chronic illness (e.g., pulmonary tuberculosis, liver disease, HIV)
- Hypercholesterolemia
- Excessive alcohol consumption
- Northern European ethnicity
- Family history
- Hand trauma
- Low body weight and body mass index
General Prevention
Avoid risk factors, especially if a strong family history.
Commonly Associated Conditions
- Alcoholism
- Epilepsy (inconstant data)
- DM
- Chronic lung disease
- Occupational hand trauma (vibration)
- Hypercholesterolemia
- Carpal tunnel syndrome
- Peyronie disease
- HIV
- Cancer
- Adhesive capsulitis of shoulder
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