Dupuytrens

Dupuytrens, also known as Dupuytren's contracture or Dupuytren's disease, is a fibrosing disorder of the palmar fascia that causes progressive flexion deformities of the fingers, most often the ring and little fingers.

The condition begins with nodules in the palm, which gradually form thick cords of collagen. These cords shorten and tighten the tissue, pulling the fingers into contracture at the metacarpophalangeal joints and, as it progresses, sometimes at the proximal interphalangeal joints.

Epidemiology and risk factors: Dupuytren's affects men more than women and typically presents after age 50. It is more common in people of Northern European ancestry. Family history increases risk, and associations include diabetes, epilepsy, alcohol use, and smoking.

Clinical evaluation and diagnosis: Diagnosis is usually clinical based on the appearance and finger contractures. Palpable nodules and cords may be felt in the palm. Imaging is not routinely required but ultrasound or MRI can be used to map extent in complex cases. Severity is commonly described by the Tubiana classification.

Treatment decisions depend on severity and functional impairment. Mild disease may be observed. Options for established contractures include enzyme injections with collagenase to weaken cords, percutaneous needle fasciotomy, or open or limited fasciectomy. Dermofasciectomy is reserved for severe or recurrent disease. Rehabilitation after treatment improves outcomes.

Prognosis and recurrence: Dupuytren's is a chronic, slowly progressive condition. Recurrence after treatment is common and can occur years after intervention. Complications can include nerve or tendon injury, stiffness, and wound infection.

History: The condition was described by Baron Guillaume Dupuytren in the 19th century; the eponym became attached to the contracture.