Dupuytren's contracture M72.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.11.2021

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Synonym(s)

Aponeurosis fibrosa palmaris; crispatura tendinuum; Dupuytren's disease; Dupuytren's finger contracture; palmar fasciitis; palmar fibromatosis

History
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Plater, 1614; Dupuytren, 1831

Definition
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Circumscribed connective tissue induration of the palmar aponeurosis with bending contracture of the fingers. Pendant on the sole of the foot plantar fibromatosis (Ledderhose syndrome), see also polyfibromatosis. The ulnar fingers are usually most severely affected. Combination with Induratio penis plastica (Peyronie's syndrome) is possible.

Occurrence/Epidemiology
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Accumulation in the Nordic cultural area (Scandinavia, Northern Germany). The prevalence is 1-17% in western cultural states: The highest prevalence is in Africa with 17%. Asoem 15%. Europe 10%, America 2%.

Etiopathogenesis
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Genetic factors cause 80% of the factors, partly autosomal-dominant inheritance, reduced penetrance and variable expressivity is assumed. Other causes include trauma, long-term work with vibrating equipment (> 15 years), liver disease, diabetes mellitus, smoking with concomitant alcohol consumption, epilepsy or dialysis. Pathogenetically, increased local production of interleukin-1, basic fibroblast growth factor, and "transforming growth factor beta" lead to local proliferation of fibroblasts and overproduction of collagen. The transformation of fibroblasts into contractile myofibroblasts and impaired apoptosis lead to contractures in the course of the disease.

Manifestation
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Mostly in men in middle to later age. Men are affected 5-10 times more often than women.

Localization
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Mainly palmar aponeurosis; initially 4th and 5th fingers.

Clinical features
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Depending on the characteristics, a distinction is made between 4 stages:

  • 1st degree: circumscribed, palpable node formation
  • 2nd degree: incipient contracture, minor obstruction of finger extension in the metacarpophalangeal joint
  • 3rd degree: Stretch impediment in the middle or base joint
  • 4th degree: Additional hyperextension in the final joint and finally bending contracture of the fingers >135º.

Mostly unilateral, rarely double-sided pressure or spontaneously painful nodular hardening of the palmar aponeurosis near the joint; bending contracture of the ulnar fingers. Depending on the examiner, combinations with the following fibromatoses occur in about 5%:

In addition, the occurrence of keloids, cirrhosis of the liver, "knuckle pads" or periarthritis humeroscapularis was observed.

Therapy
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Treatment depending on the severity by experienced hand surgeons (see Table 1).

Progression/forecast
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Recurrence rate after limited fasciectomy: 12-73% after 5 years; percutaneous needle fasciotomy: 85% after 2.3 years.

As prophylaxis in case of high familial risk or postoperatively in case of high risk of recurrence radiotherapy is to be considered.

Tables
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Therapy of Dupuytren's contracture

Clinic

Therapy

1st degree

Circumscribed, palpable nodal formations without contracture

Physiotherapy, night splint, if necessary intralesional glucocorticoids1

2nd degree

Incipient contracture, slight impairment of finger extension in the base joint

Operative: limited fasciectomy / percutaneous needle fasciotomy

3rd degree

Impairment of extension in the middle or base joint

like grade 2

4th degree

Additional hyperextension in the terminal joint and ultimately flexion contracture of the fingers

as grade 2, in case of affection of the flexor tendons: tendon lengthening, ultima ratio: dermofasciectomy with skin replacement

Note(s)
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In a larger study (308 Pat), good results were achieved with intralesional application of collagenase from Clostridium histolyticum.

Literature
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  1. Baird KS, Crossan JF, Ralston SH (1993) Abnormal growth factor and cytokine expression in Dupuytren's contracture. J Clin Pathol 46: 425-428
  2. Brenner P et al. (2001) Dupuytren contracture in North Germany. Epidemiological study of 500 cases. Trauma Surgeon 104: 303-311
  3. Dupuytren G (1831) De la rétraction des doigts par suite d'une affection de l'aponévrose palmaire. Opération chirurgicale, qui convient dans le cas. J Univ hebd Méd Chir prat Paris 5: 352-365.
  4. Lopatecki M (2003) Dupuytren's contracture: aftercare and long-term results. Orthopaedics 32: 394-396
  5. Orlando JC, Smith JW, Goulian D (1974) Dupuytren's contracture: A review of 100 patients. Brit J Plast Surg 27: 211-217
  6. Plater F (1614) Observationum in hominis affectibus. Liber I, L. König, Basel, p. 140
  7. Vogl A et al (2005) Skin and alcohol. J Dtsch Dermatol Ges 3: 788-790
  8. Ruettermann M et al (2021) Dupuytren's disease: etiology and treatment. Dtsch Arztebl Int: 118: 781-788

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.11.2021