173: DUPUYTREN CONTRACTURE

CONDITION/DISORDER SYNONYMS

• Morbus Dupuytren

• Dupuytren disease

• Palmar fasciitis

• Palmar fibromatosis

ICD-9-CM CODE

• 728.6 Contracture of palmar fascia

ICD-10-CM CODE

• M72.0 Palmar fascial fibromatosis [Dupuytren]

PREFERRED PRACTICE PATTERN

• 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction¹

KEY FEATURES

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics

• 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

CLINICAL FINDINGS

Functional Implications

• Limitation in opening hand, extending fingers fully

• Can limit ability to shake hands

Possible Contributing Causes

• Smoking may decrease vascular changes in the hands

• Alcoholism³

• Epilepsy⁴

• Pulmonary tuberculosis⁵

• Diabetes

• Liver disease or cirrhosis

  • Heredity: heterogeneous

    ...