Anatomy Msk · Year 1 · from Anatomy Msk
Case 3: Dupuytren's Contracture
Clinical Image
Source: Wikimedia Commons - Dupuytren's Contracture - CC BY-SA 3.0
Case Presentation
A 65-year-old man of Northern European descent presents with progressive inability to fully straighten his right ring and small fingers over the past 2 years. He first noticed a firm nodule in his palm several years ago that has gradually enlarged. He is a retired carpenter with a history of diabetes and moderate alcohol consumption. He now has difficulty placing his hand flat on a table, putting on gloves, and reaching into his pocket. Physical examination reveals palpable nodules and cords in the palmar fascia overlying the ring and small finger metacarpals. The metacarpophalangeal (MCP) joint of the ring finger has a 45-degree fixed flexion contracture, and the proximal interphalangeal (PIP) joint has a 30-degree contracture. The small finger MCP has a 35-degree contracture. The overlying skin is dimpled and adherent to the underlying fascia. Tabletop test is positive (cannot place palm flat on table). There is no triggering, and finger flexion strength is normal. The patient undergoes limited fasciectomy with good correction of the contractures.
Key Learning Points
- Dupuytren's contracture is fibromatosis of the palmar fascia causing progressive finger flexion contracture
- The palmar aponeurosis has longitudinal pretendinous bands extending to each digit that become pathologically thickened
- Risk factors: Northern European ancestry, male sex, age >50, diabetes, alcohol use, smoking, family history
- The ring and small fingers are most commonly affected; MCP contractures are most common, followed by PIP
- Treatment indications include MCP contracture >30 degrees, any PIP contracture, or positive tabletop test