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Condition/Disorder Synonyms

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  • Morbus Dupuytren

  • Dupuytren's disease

  • Palmar fasciitis

  • Palmar fibromatosis

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ICD-9-CM Code

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  • 728.6 Contracture of palmar fascia

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ICD-10-CM Code

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  • M72.0 Palmar fascial fibromatosis [Dupuytren]

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Preferred Practice Pattern

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Key Features

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Description

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  • Usually painless thickening of the fascia, contraction of palmar fascia (aponeurosis)

  • Nodules develop along longitudinal tension lines

  • Characterized by development of nodules in the palmar and digital fascia

  • Can be associated with other fascial contractures

    • Feet (Ledderhose disease), callus under foot with curling of toes

    • Penis (Peyronie's disease), curvature

    • Garrod's knuckles, pads on back of finger knuckles

  • Named after Baron Guillaume Dupuytren

  • Viking disease

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Essentials of Diagnosis

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  • Classified into three biologic stages

    • First stage (proliferative stage): intense proliferation of myofibroblasts (cells believed to generate the contractile forces responsible for tissue contraction) and formation of nodules

    • Second stage (involutional stage): represented by alignment of the myofibroblasts along lines of tension

    • Third stage (residual stage): tissue becomes mostly acellular and devoid of myofibroblasts, only thick bands of collagen remain

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General Considerations

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  • Not usually associated with trauma, but can develop after surgery

  • Unknown etiology, possibly autoimmune

  • Usually bilateral with one side more severely affected

  • Early stages based on palpable nodule, characteristic skin changes, changes in fascia, progressive joint contracture

  • Skin changes caused by a retraction of skin, creating dimples or pits

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Demographics

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  • Caucasian with Scandinavian/Northern European decent

  • Usually associated with family history

  • Rare with children

  • Men 7 to 15 times more likely than women to require surgery

  • Females develop less severe cases

  • Incidence increases with age > 40 years

  • Higher incidence among people with alcoholism, diabetes, epilepsy

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Clinical Findings

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Signs and Symptoms

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  • Thickening and shortening of fascia of the hand

  • Contractures form at metacarpophalangeal (MCP), proximal interphalangeal (PIP), and occasionally distal interphalangeal (DIP) joints

  • Fifth finger involved in 70% of cases

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Functional Implications

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  • Limitation in grasping, opening hand, extending fingers fully

  • Can limit ability to shake hands

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Possible Contributing Causes

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Differential Diagnosis

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Means of Confirmation or Diagnosis

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Diagnostic Procedures

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  • Visual and palpation for thickened scar tissue (fibrosis)

  • Tabletop test; negative if able to lay hand flat on a table, palm down

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Treatment

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Medication

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  • Enzyme injection; ...

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