Dupuytren's Contracture - Assessment

 

Dupuytren's Contracture Pathway

History

•Assess symptoms, functional limitations (e.g., difficulty with face washing, pocket use), hand dominance, and occupation.

•Risk factors: age, male sex, family history (autosomal dominant), Northern European descent.

•Other contributors: diabetes, smoking, alcohol, epilepsy, hypercholesterolemia, manual labor, prior hand trauma.

Examination

•Tabletop test (positive if fingers cannot fully straighten).

•Look for nodules, skin thickening, pitting, contractures (commonly 4th & 5th digits), and visible cords.

•Check for associated conditions: Garrod's knuckle pads, Ledderhose disease (plantar fibromatosis), Peyronie’s disease (penile fibromatosis).

Diagnosis & Differentials

•Usually clinical; consider HbA1c/LFTs if diabetes or alcohol-related.

•Rule out: callus, ganglion cyst, trigger finger, ulnar nerve palsy, Volkmann’s contracture, diabetic cheiroarthropathy.

Management

•Conservative: No treatment if no contracture or contracture <20°. Consider steroid injections for painful nodules. Splinting and radiotherapy are ineffective. Provide patient information.

•Surgical Referral: Required for contracture or functional impairment. Referral to hand/plastic/orthopedic surgeon, with prior approval if necessary