Dupuytren Contracture Clinical Presentation

Updated: Nov 20, 2018
  • Author: Eva Kovacs, MD; Chief Editor: Herbert S Diamond, MD  more...
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Presentation

History

Obtain a thorough medical history when evaluating a patient thought to have Dupuytren contracture. Presenting symptoms typically include the following:

  • Decreased range of motion

  • Loss of dexterity

  • Getting the hand "caught" when trying to place it in a pocket

Conditions possibly related to Dupuytren contracture include the following:

  • Diabetes mellitus

  • Alcohol abuse

  • HIV infection

  • Epilepsy

  • Trauma

  • Manual labor with vibratory exposure

  • Cigarette smoking

Patients describe feeling a knot or thickening on the palmar surface or, less frequently, on the digits, typically the proximal palmar aspect. Often, the thickening has been present for many years and may be slowly progressive.

The fourth digit (ring finger) is most frequently affected, followed by the fifth digit. The disease can be bilateral but is generally not symmetric in severity. Hand dominance is not a factor. Nodules typically are painless, unless nerve compression or tenosynovitis is present. Tenosynovitis can develop and lead to pain when the nodules are large. With progressive disease, flexion deformity can develop and patients will report an inability to straighten the fingers.

Asking about functional disabilities may elicit a history of certain tasks that the individual can no longer perform, such as grasping objects and typing. No sensory deficits are reported unless there is a concomitant pathology. The condition is painless in its later stages.

Next:

Physical Examination

Perform a thorough physical examination focusing on the involved extremity. A careful physical examination often confirms the diagnosis without the need for further tests. [55]

Important points to assess include the following:

  • Firm nodules that may be tender to palpation: The nodules are closely adherent to the skin; movement of the nodule with finger motion suggests an association with the tendon and not Dupuytren contracture. See the image below.

    This photo demonstrates the presence of a nodule a This photo demonstrates the presence of a nodule as well as skin blanching with extension of the affected digits.
  • Painless cords proximal to the nodules

  • Skin blanching upon active finger extension

  • Atrophic grooves or pits in the skin: These represent adherence to the underlying fascia.

  • Tender knuckle pads over the dorsal aspect of the PIPs (Garrod nodes): These occur in 44-54% of patients and suggest more aggressive disease. [3]

  • Plantar fascia involvement, known as Ledderhose disease (6-31%): This can indicate more severe disease. [3]

  • Presence of MCP and PIP joint contractures: Objectively measure and record the degree of flexion contracture and assess for compensatory DIP joint hyperextension or contracture.

  • Hueston table top test: If the patient is unable to lay the palm flat on a tabletop, the findings are considered positive.

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