Dupuytren’s Contracture

Dupuytren's contracture occurs when the connective tissue (fascia) in the palm and fingers thickens into nodules and cords. It can result in finger contractures

Assessment

Dupuytren's typically presents with some of the following:

skin thickening or pitting in the palm
firm nodules that can be tender and inflamed in the early stages
fibrous, tendon-like cords
contractures of the cords:
- flexion deformity at the metacarpophalangeal / interphalangeal joints
- confirmed if the person is unable to lay their hand flat on a table top
one or both hands may be affected
the ring finger is most commonly affected, followed by little and middle fingers
the thumb and index fingers are usually spared
family history often positive

Investigations

Clinical diagnosis

Management

Treatment is not commissioned in cases where there is no contracture, and in patients with mild (less than 20°) contractures, or one which is not progressing and does not impair function

For these patients:

provide explanation of the condition and advice; this can be a progressive, but benign disease, with finger contractures developing later
no treatment is necessary whilst there are no contractures
reassure that tender nodules will become less tender over time
advise the person to return when they cannot flatten their outstretched hand

Splinting and corticosteroid injections are not of benefit

Referral

Referral criteria

Treatment is not commissioned in cases where there is no contracture, and in patients with mild (less than 20°) contractures, or one which is not progressing and does not impair function.