Dupuytren contracture

A Dupuytren contracture (or palmar fibromatosis) is a fibrosing condition characteristically presents as a firm nodularity on the palmar surface of the hand with coalescing cords of soft tissue on the webs and digits.

Epidemiology

It is considered the most common of the superficial fibromatoses and is though to affect 1-2% of the population. People of northern european descent are typically affected with highest prevalence in countries such as northern Scotland, Iceland, Norway, and Australia ². Age at presenation typically peaks around 65. There may be an increased male predilection.

Associations

Additional diseases that are associated with palmar fibromatosis include

• diabetes mellitus
• epilepsy
• alcoholism (particularly liver disease related to alcoholism)
• keloids
• plantar fibromatosis

Clinical presentation

Patients typically present with palmar surface subcutaneous nodules on the of the distal crease of the hand. This may progresses to cords and bands and, finally, the characteristic flexion contracture secondary to fibrous attachments to the underlying tendon sheath.

Pathology

It is progressive condition that causes shortening and thickening of the fibrous tissue of the palmar fascia.

Location

• lesions can be bilateral in about half of cases ⁷
• the 4^th ray is typically involved ⁶

Radiographic features

MRI

The lesions typically comprise of subcutaneous nodules, usually at the level of the distal palmar crease, and cords that lie parallel and superficial to the flexor tendons.

Signal characteristics of the cords include

Typical (~ 80% of cases) ¹

• T1: - uniformly uniformly low signal intensity (similar to the signal intensity of tendon)
• T2: - uniformly uniformly low signal intensity (similar to the signal intensity of tendon)

Atypical ¹

• T1: - low low to intermediate signal intensity (a slightly higher signal intensity than that of tendon)
• T2: - low signal intensity 

EtymologyHistory and etymology

It was originally described in 1831 by the French physician Dupuytren ²

Treatment

A medical or surgical intervention may be required in patients suffering from a functional impairment (significant inability to use their hands for routine activities) or due to cosmetic embarrassment. Medical intervention includes triamcinolone, lidocaine, or collagenase injection. Vitamin E, gamma interferon, dimethyl sulfoxide, and splinting are the wrong treatment modalities for dupuytren's contracture. Surgical release of palmar fascia is usually indicated in patients with severe functional impairment and neurovascular deficit in a finger ⁸.  

See also

• nodular fasciitis