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  • Morbus Dupuytren
  • Dupuytren's disease
  • Palmar fasciitis
  • Palmar fibromatosis

  • 728.6 Contracture of palmar fascia

  • M72.0 Palmar fascial fibromatosis [Dupuytren]

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's disease), curvature
    • Garrod’s 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

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

Functional Implications

  • Limitation in grasping, opening hand, extending fingers fully
  • Can limit ability to shake hands

Possible Contributing Causes

Differential Diagnosis

Diagnostic Procedures

  • Visual and palpation for thickened scar tissue (fibrosis)
  • Tabletop test; negative if able to lay hand flat on a table, palm down

Medication

  • Enzyme injection; collagenase clostridium
  • Histolyticum to soften and break down taught bands

  • To hospital for surgery to release fascia
  • For acupuncture
  • To physician for enzyme injection of the collagen-eroding enzyme collagenase
  • To physician for radiotherapy, radiation therapy (low energy x-rays)

  • Restricted movement of hand and fingers
  • Hand ...

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