QuestionSBA
QuestionChoice
This is incorrect. Patients >40 years old are at a greater risk of developing Dupuytren’s contracture.
10017152
b
Age <20 years old
QuestionChoice
This is incorrect. Patients who smoke are at greater risk of developing Dupuytren’s contracture.
10017155
e
Negative smoking history
QuestionChoice
This is incorrect. Patients of Northern European descent are at greater risk of developing Dupuytren’s contracture.
10017154
d
Mediterranean descent
QuestionChoice
The condition described here is Dupuytren’s contracture, which is a progressive flexion contracture of the fingers due to connective tissue proliferation and nodule formation in the palm. Positive family history is a significant risk factor for the development of Dupuytren’s contracture.
10017151
a
Positive family history
QuestionChoice
This is incorrect. Male patients are at a greater risk of developing Dupuytren’s contracture.
10017153
c
Female sex
Concept
Chapter
# Summary

Dupuytren's contracture is a hand deformity that gradually develops due to fibrotic thickening of the palmar fascia, most notably affecting the 4th and 5th digits. Risk factors include idiopathic origins, diabetes, chronic alcohol use with associated liver disease, familial history, AIDS, and Peyronie's disease. The condition is primarily diagnosed through clinical evaluation, and management ranges from conservative measures like physiotherapy and exercises to surgical fasciectomy.

# Definition

Dupuytren's contracture is a pathophysiological condition characterised by the progressive, fibrotic thickening of the palmar fascia that results in permanent flexion deformity of the affected fingers, predominantly the 4th and 5th digits.

# Epidemiology

Dupuytren's contracture most commonly affects individuals of Northern European descent and males more frequently than females, with the prevalence increasing with age. The condition often presents in individuals over the age of 50. It's estimated that about 4-6% of the population in the United States suffers from this condition, with a significantly higher prevalence noted in individuals of Scandinavian descent, where it may affect up to 30% of the population.

# Aetiology

Dupuytren's contracture may arise due to a variety of factors:

-   Idiopathic: This is the most prevalent cause.
-   Diabetes: Chronic diabetes heightens the risk.
-   Excess alcohol use with chronic liver disease: Higher incidence is correlated with chronic liver disease and heavy alcohol consumption.
-   Family history: There is often a genetic predisposition.
-   AIDS: A higher incidence has been noted in HIV patients.
-   Peyronie's disease: An association has been noted with this connective tissue disorder.

# Signs and Symptoms

The key clinical features of Dupuytren's contracture include:

-   Fixed flexion deformity of the 4th and 5th digit
-   Contraction at the metacarpophalangeal and interphalangeal joints
-   In many instances, a symmetrical and bilateral presentation

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# Differential Diagnosis

The differential diagnosis for Dupuytren's contracture primarily includes:

-   **Trigger finger**: This is characterised by finger stiffness, clicking, and a sensation of locking or catching when the finger is bent and straightened.
-   **Carpal tunnel syndrome**: Symptoms include numbness, tingling, and weakness in the hand, particularly affecting the thumb and the first three fingers.
-   **Diabetic cheiroarthropathy**: This presents with limited joint mobility and a thick, tight, waxy skin on the back of the hands.

# Investigations

Diagnosis of Dupuytren's contracture is primarily clinical, based on presentation of typical symptoms and findings on physical examination.

# Management

The management strategies for Dupuytren's contracture are:

-   Conservative measures: These include physiotherapy and exercises to help maintain finger mobility and strength.
-   Surgical intervention: Surgical fasciectomy may be considered when conservative management is ineffective. This procedure involves the removal of the thickened tissue and creation of a z-shaped scar to mitigate recurrence.

# External link

[Click here for more information on Dupuytren's contractures](https://teachmesurgery.com/orthopaedic/wrist-and-hand/dupuytrens-contracture/)
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The classical appearance of dupuytren's contracture.
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Dupuytren's contracture
Topic
37
Orthopaedics
15974
Dupuytren’s contracture is characterised by progressive flexion of the fingers due to palmar fascia thickening, often associated with a positive family history.
A 46-year-old male has thickening of tissue and palpable nodules over the fourth and fifth digits on the palm of his right hand. The fingers are slightly flexed, and the patient is unable to flatten his right hand on the table.

Given the likely diagnosis, which of the following is a risk factor for the development of this condition?
a