Dupuytren's contracture

Background

• Dupuytren's contracture is a progressive, permanent flexion of the digits of the hand due to myofibroblastic disease of the palmar and digital fascia
• It most commonly affects the fourth and fifth digits
• Unilateral contracture predominately affects the right side but bilateral involvement is common

Clinical Features

• Initially, painless nodules are present longitudinally along the lines of tension
• Contracture deformities within fascial bands of the hand occur when the nodules form cords
• Blanching of the digit on extension
• Proximal to the nodules, the cords are painless
• Pits and grooves may be present
• The knuckle pads over the PIP joints may be tender
• If the plantar fascia is involved, this indicates more severe disease (Ledderhose disease)
• The tabletop test (Hueston) is performed by having the patient attempt to place the palm flat on the exam table. If there is any flexion contracture deformity, the patient will be unable to straighten the fingers, resulting in a positive test.

Differential Diagnosis

• Rheumatoid Arthritis
• Extensor tendon rupture
• Extensor tendon injury