eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

Dupuytren Contracture: Differential Diagnoses & Workup

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Contributor Information and Disclosures

Updated: Feb 4, 2010

Differential Diagnoses

Clavus
Epidermal Inclusion Cyst
Giant Cell Tumor of the Tendon Sheath
Trigger Finger

Other Problems to Be Considered

Changes secondary to rheumatoid arthritis
Epithelioid sarcoma
Hyperkeratosis
Non-Dupuytren disease
Palmar ganglion
Stenosing tenosynovitis

A locked trigger finger may present with some similarities to Dupuytren contracture. Finger flexor contracture due to joint or tendon pathology may cause a presentation similar to that of Dupuytren contracture. However, it is notable that in Dupuytren contracture, the tendon is spared; only the fascia is involved.

Workup

Laboratory Studies

  • Generally, no laboratory studies are needed in the diagnosis of Dupuytren contracture.

Imaging Studies

  • As a rule, radiography or other imaging studies are unnecessary.

Procedures

  • Nonsurgical procedures do not appear to have a role in the diagnosis of this condition.

Histologic Findings

Nodular, hypertrophic degeneration of the palmar fascia with adherence to the overlying skin is noted. Pathologically, the contracture consists of proliferating, vascular, fibrous tissue that later develops into mature collagen. Dermis typically is involved, resulting in fixation to the fascia.6

More on Dupuytren Contracture

Overview: Dupuytren Contracture
Differential Diagnoses & Workup: Dupuytren Contracture
Treatment & Medication: Dupuytren Contracture
Follow-up: Dupuytren Contracture
Multimedia: Dupuytren Contracture
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Bansal V, Naidu SH. Dupuytren's disease. Curr Opin Orthop. 2005;16(4):236-9.

  2. Vi L, Feng L, Zhu RD, Wu Y, et al. Periostin differentially induces proliferation, contraction and apoptosis of primary Dupuytren's disease and adjacent palmar fascia cells. Exp Cell Res. Dec 10 2009;315(20):3574-86. [Medline].

  3. Loos B, Puschkin V, Horch RE. 50 years experience with Dupuytren's contracture in the Erlangen University Hospital--a retrospective analysis of 2919 operated hands from 1956 to 2006. BMC Musculoskelet Disord. 2007;8:60. [Medline]. [Full Text].

  4. Bayat A, Cunliffe EJ, McGrouther DA. Assessment of clinical severity in Dupuytren's disease. Br J Hosp Med (Lond). Nov 2007;68(11):604-9. [Medline].

  5. Hnanicek J, Cimburova M, Putova I, et al. Lack of association of iron metabolism and Dupuytren's disease. J Eur Acad Dermatol Venereol. Apr 2008;22(4):476-80. [Medline].

  6. Balaguer T, David S, Ihrai T, et al. Histological staging and Dupuytren's disease recurrence or extension after surgical treatment: a retrospective study of 124 patients. J Hand Surg Eur Vol. Aug 2009;34(4):493-6. [Medline].

  7. Anwar MU, Al Ghazal SK, Boome RS. Results of surgical treatment of Dupuytren's disease in women: a review of 109 consecutive patients. J Hand Surg [Am]. Nov 2007;32(9):1423-8. [Medline].

  8. Mavrogenis AF, Spyridonos SG, Ignatiadis IA, et al. Partial fasciectomy for Dupuytren's contractures. J Surg Orthop Adv. Summer 2009;18(2):106-10. [Medline].

  9. Ullah AS, Dias JJ, Bhowal B. Does a 'firebreak' full-thickness skin graft prevent recurrence after surgery for Dupuytren's contracture?: a prospective, randomised trial. J Bone Joint Surg Br. Mar 2009;91(3):374-8. [Medline].

  10. Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg [Am]. Nov 2000;25(6):1157-62. [Medline].

  11. Badalamente MA, Hurst LC. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren's contracture. J Hand Surg [Am]. Jul-Aug 2007;32(6):767-74. [Medline].

  12. Badalamente MA, Hurst LC, Hentz VR. Collagen as a clinical target: nonoperative treatment of Dupuytren''s disease. J Hand Surg [Am]. Sep 2002;27(5):788-98. [Medline].

  13. Starkweather KD, Lattuga S, Hurst LC, et al. Collagenase in the treatment of Dupuytren''s disease: an in vitro study. J Hand Surg [Am]. May 1996;21(3):490-5. [Medline].

  14. Hurst LC, Badalamente MA, Hentz VR, et al. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. Sep 3 2009;361(10):968-79. [Medline].

  15. Trojian TH, Chu SM. Dupuytren's disease: diagnosis and treatment. Am Fam Physician. Jul 1 2007;76(1):86-9. [Medline].

  16. Corrado A, Cantatore FP. [Dupuytren's disease. State of the art and therapeutic perspectives]. Reumatismo. Apr-Jun 2007;59(2):118-28. [Medline].

  17. Breen TF. Wrist and hand. In: Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:99-138.

  18. Brinker MR, Miller MD. The adult hand. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:196-220.

  19. Dupuytren's disease. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:198-9.

  20. McGee DJ. Forearm, wrist and hand. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:168-215.

  21. Rayan GM. Dupuytren disease: Anatomy, pathology, presentation, and treatment. J Bone Joint Surg Am. Jan 2007;89(1):189-98. [Medline].

  22. Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:756-82.

[ CLOSE WINDOW ]

Keywords

Dupuytren contracture, Dupuytren's contracture, Dupuytren's disease, Dupuytren disease, PIP joint, MCP joint, palmar fasciitis, palmar fibromatosis, Viking disease, metacarpophalangeal joint deformity, MCP joints, fasciectomy, proximal interphalangeal joint deformity, PIP joints

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Rajesh R Yadav, MD, Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas at Houston
Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.