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CONDITION/DISORDER SYNONYMS
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Morbus Dupuytren
Dupuytren disease
Palmar fasciitis
Palmar fibromatosis
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PREFERRED PRACTICE PATTERN
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4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1
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PATIENT PRESENTATION
A 53-year-old man presents with stiffness in his hands. He says his hand began to feel stiff several years ago, and now he finds that he cannot straighten many of his fingers. He delayed seeing a physician because he did not feel any pain in his hands. He recently began having difficulty holding his woodworking tools and wants to regain the function he has lost in his hands.2
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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 disease), curvature
Garrod 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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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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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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SIGNS AND SYMPTOMS
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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Possible Contributing Causes
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