Dupuytren contracture
Summary
Dupuytren contracture is a fibroproliferative disorder of the palmar fascia leading to progressive flexion contractures of the fingers, most commonly the ring and little fingers. It is associated with alcoholism, cirrhosis, diabetes mellitus, smoking, and phenytoin use, and is more common in males of Northern European descent.
Detail
Dupuytren contracture results from myofibroblast proliferation and abnormal collagen (type III) deposition within the palmar fascia, leading to nodule formation and progressive thickening and contracture of the palmar fascia bands. This causes flexion deformity of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, most often affecting the 4th (ring) and 5th (little) fingers. The disease progresses through phases: proliferative (fibroblast/myofibroblast proliferation), involutional (collagen alignment along tension lines), and residual (fascia matures into fibrous cords). It is more prevalent in men over 40, particularly of Northern European (Viking) ancestry, and shows a strong genetic predisposition (autosomal dominant with variable penetrance). Risk factors include alcohol use disorder, liver cirrhosis, diabetes mellitus, smoking, manual labor/vibration exposure, and certain drugs (e.g., phenytoin). Clinically, patients present with painless nodules and cords in the palm progressing to inability to fully extend the affected fingers (positive 'tabletop test'—inability to place the hand flat on a table). Diagnosis is clinical. Treatment options include collagenase clostridium histolyticum injection, needle aponeurotomy, or surgical fasciectomy for severe contractures. It should be differentiated from other fascial fibromatoses like plantar fibromatosis (Ledderhose disease) and penile fibromatosis (Peyronie disease), which may coexist.
Sources
- First Aid for the USMLE Step 1
- Robbins Basic Pathology
- UpToDate: Dupuytren's contracture
- Harrison's Principles of Internal Medicine
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