Dupuytren's contracture: Difference between revisions
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==Background== | ==Background== | ||
*progressive, permanent flexion of the digits of the hand due to myofibroblastic disease of the palmar and digital fascia | *A progressive, permanent flexion of the digits of the hand due to myofibroblastic disease of the palmar and digital fascia | ||
*most commonly affects the fourth and fifth digits | *It most commonly affects the fourth and fifth digits | ||
* | *Unilateral contracture predominately affects the right side but bilateral involvement is common | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Morbus dupuytren fcm.jpg|thumb|Dupuytren's contracture of the ring finger]] | |||
[[File:Dupuytren's2010.jpg|thumb|Dupuytren's contracture of the right little finger. Arrow marks the area of scarring]] | |||
*Initially, painless nodules are present longitudinally along the lines of tension | *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 | *Contracture deformities within fascial bands of the hand occur when the nodules form cords | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
* [[Rheumatoid Arthritis]] | |||
* Extensor tendon rupture | |||
* Extensor tendon injury | |||
{{Hand and finger injury DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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===Diagnosis=== | ===Diagnosis=== | ||
*Typically a clinical diagnosis | |||
==Management== | ==Management== | ||
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==Disposition== | ==Disposition== | ||
*Outpatient management | |||
==See Also== | ==See Also== | ||
Latest revision as of 18:56, 31 May 2023
Background
- 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.[1]
Differential Diagnosis
- Rheumatoid Arthritis
- Extensor tendon rupture
- Extensor tendon injury
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
Workup
Diagnosis
- Typically a clinical diagnosis
Management
Disposition
- Outpatient management