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
Genetics
  • 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 HLA 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 BMI

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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