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Clinical Presentation





How common is Dupuytren's contracture?

It depends on the genetic makeup of the population. Dupuytren's is estimated to affect 3% of the US population

What areas are most often affected?

  • Dupuytren's is a change in normal structures, transforming the superficial palmar fascia into cords, and joins fascia to the undersurface of the skin to form nodules. Although resembling a tumor in some ways, it is not. The longitudinal (lengthwise) fibers of the superficial palmar fascia are clinically affected, but transverse (sideways) fibers also show chromosomal evidence of involvement. Although only certain regions of the fascia appear affected, the biochemistry of the entire fascia is abnormal. The ring finger is most commonly affected, then the small finger, and then the thumb (28%). Thumb involvement can take many forms, and usually occurs when other fingers are affected. Rarely, the wrist may be involved. "Knuckle pads" on the dorsal PIP joints are apparently the same process as nodules in the palm. Although neither produce contractures, knuckle pads are associated with more aggressive forms of the disease. Isolated cords in the fingers may develop between the proximal phalanx periosteum (bone lining at the base of the finger) and the flexor tendon sheath at the middle phalanx level. Abductor pollicis muscle and tendon involvement may affect small finger contractures.
  • Normally, the skin is anchored down to the underlying fascia by many tiny tissue strands running perpendicular down to the fascia. When the fascia shrinks, these threads pull the skin, and may result in nodules, dimples, or both contour changes:
  • Secondary changes may also occur. The position of the finger nerves may be shifted by the growth of a "spiral cord", especially when the PIP joints become contracted. Extensor tendons on the back of the finger may be indirectly affected: the central slip tendon which straightens the PIP joint may become stretched out from the joint being bent for a long time, and the transverse retinacular ligaments on the sides of the joint may become fibrotic, resulting in a boutonniere deformity.
  • Rarely, the extensor tendons may be affected by PIP knuckle pads or distal to the PIP joint. Other changes in the PIP joint may prevent full correction of contracture using surgical techniques which work for non-Dupuytren's PIP contractures. Bone spurs may develop in the finger bones as a result of tension on the attachments to bones. Rarely, the DIP joints are involved.
  • Outside the hand, the sole of the foot (Ledderhose's disease) and the penis (Peyronie's Disease) may be affected in a similar fashion. The combination of all three conditions - Dupuytren's diathesis, Ledderhose's contracture and Peyronie's disease - is referred to as Dupuytren's diathesis and is associated with a particularly aggressive condition.

Last updated 10.2.08

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