Dupuytren disease is a fibrosing disorder that results in slowly progressive thickening and shorting of the palmar fascia and leads to debilitating digital contractures, particularly of the metacarpophalangeal (MCP) joints or the proximal interphalangeal (PIP) joints. This condition usually affects the fourth and fifth digits (the ring and small fingers).
Dupuytren contracture is most commonly observed in persons of Northern European descent and affects 4-6% of Caucasians worldwide. Many individuals have bilateral disease (45%), in unilateral cases, the right side is more often affected. The effects of morbidity in Dupuytren contracture are generally limited to lifestyle changes. Approximately 80% of affected individuals are male; this is consistent throughout all countries and races. Approximately 80% of affected individuals are male; this is consistent throughout all countries and races. The disease onset in males tends to occur in the fifth to sixth decade. Men tend to present a decade earlier than females.
Dupuytren disease occurs in the following three stages. Proliferative phase, during this phase, myofibroblasts proliferate and a nodule develops. In early disease, some patients may report tenderness and discomfort associated with the nodules. Involutional phase spreads along the fascia and into the fingers resulting in the development of a cord. Residual phase during this, the disease continues to spread into the fingers and the cord tightens creating a contracture.
Stretching with the application of heat and ultrasonographic waves may be helpful in the early stages of Dupuytren contracture. The postsurgical program consists of wound care, massage, passive stretching, active ROM exercises, and splinting. Intralesional triamcinolone acetonide (Kenalog-40) injections of 40 mg/mL have yielded subjective improvement in the size of Dupuytren nodules in some patients. orticosteroids are associated with a high risk of complications, including fat atrophy and skin discoloration. Radiotherapy can be effective in slowing disease progression in the early stages of Dupuytren contracture but was not effective in advanced disease. Injected collagenase extracted from C histolyticum weakens and dissolves the Dupuytren cord.