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.

Refer to Hand Clinic

Medical treatment of Dupuytren's contracture with collagenase injections (Xiapex®) is commissioned in accordance with NICE technology appraisal TA459:

In adults with a palpable cord only if all of the following apply:

  • There is evidence of moderate disease (functional problems and metacarpophalangeal joint contracture of 30° to 60° and proximal interphalangeal joint contracture of less than 30° or first web contracture) plus up to 2 affected joints.
  • Percutaneous needle fasciotomy (PNF) is not considered appropriate, but limited fasciectomy is considered appropriate by the treating hand surgeon.
  • The choice of treatment (CCH or limited fasciectomy) is made on an individual basis after discussion between the responsible hand surgeon and the patient about the risks and benefits of the treatments available.
  • One injection is given per treatment session by a hand surgeon in an outpatient setting.

Surgical intervention (needle fasciotomy, fasciectomy and dermofasciectomy) is commissioned for:

  • a) Finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint

or

  • b) Severe thumb contractures which interfere with function

(For further information see link to the NHS Devon Dupuytren's Contracture Treatment commissioning policy)

Referral Instructions

Refer to the Hand Clinic (Orthopaedics)

Please refer using the e-Referral Service

  • Specialty: Orthopaedics
  • Clinic Type: Hand and Wrist
  • Service: DRSS-Northern-Orthopaedics Hand & Wrist- Devon CCG-15N

Referral Forms

DRSS Referral Porforma

Supporting Information

GP Information

NHS Devon Dupuytren's Contracture Treatment commissioning policy

Patient Information

MyHealth patient information - Dupuytrens

Dupuytren's Contracture patient information

Pathway Group

This guideline has been signed off on behalf of NHS Devon CCG.

Publication date: March 2017

Updated: October 2019

 

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