Case 58 Dupuytren’s Contracture

Charles C. Jehle and Reena A. Bhatt

Case 58 Dupuytren’s Contracture

Case 58 A 67-year-old Caucasian male presents with painless progressive loss of motion of the left ring finger as well as palmar nodules. He is unable to straighten his metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints actively or passively.

58.1 Description

  • Flexion contracture of the left ring finger that includes the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints

  • Palmar cords and nodules visible over middle, ring, and small rays consistent with Dupuytren’s contracture

58.2 Work-Up

58.2.1 History

  • Symptoms and degree of impairment of activities

  • Age at presentation and duration of the disease

  • Family history of Dupuytren’s disease

    • Dupuytren’s diathesis: Young age at onset, positive family history, bilateral disease, and ectopic lesions

    • More prevalent in northern Europeans and Japanese

  • Sex: More common in males

  • May have history of plantar fascia (ledderhose disease) or Penile (peyronie disease) involvement

  • Risk factors: Alcohol, epilepsy medications, diabetes mellitus, and smoking

  • Previous surgical treatment for this condition

  • Trauma to the palm can result in traumatic palmar fasciitis

58.2.2 Physical Examination

  • Observe presence and location of pits, modules, and cords

    • Palpate for symptomatic nodules and cords

  • Note digits and joints involved, and measure the degree of contracture

    • Tabletop test: Patient is unable to lay the palm flat on a rigid surface

    • Adduction contracture of the thumb

  • Assess integrity of extensor mechanism

    • Flex wrist and MCP joint to create tenodesis effect

    • An extensor lag indicates that the central slip is attenuated and postoperative extension splinting may be required; the patient should be cautioned that full extension of the affected finger will likely not be regained

  • Sensory examination of all digits

  • Sites of ectopic disease

    • Garrod’s nodes (nodules on dorsum of PIP joint) and knuckle pads (fibrosing lesions on dorsum of PIP joint)

    • Ledderhose disease (plantar fibromatosis)

    • Peyronie’s disease (penile fibromatosis)

Only gold members can continue reading. Log In or Register to continue

Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 58 Dupuytren’s Contracture
Premium Wordpress Themes by UFO Themes