hand
Dupuytren's Disease
intermediate
6 min
28 marks
6 questions
Clinical Scenario
A 62-year-old man of Northern European descent presents with progressive difficulty straightening his right ring finger over the past 2 years. He is a retired builder with a history of heavy alcohol use and type 2 diabetes. On examination, there is a palpable cord from the palm to the proximal phalanx of the ring finger. The MCP joint has a 35° fixed flexion contracture and the PIP has a 25° contracture. He cannot place his palm flat on the table. The small finger has a nodule but no contracture. Sensation is intact.
Clinical photograph of the right hand showing Dupuytren's disease. A palpable cord extends from the palm to the ring finger causing MCP flexion contracture of 40° and PIP contracture of 30°. Skin pitting is visible over the cord. The small finger shows early nodule formation. The table-top test is positive (palm cannot be placed flat on table). This patient meets criteria for fasciectomy (MCP >30° or PIP >20°).
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the anatomy of the palmar fascia and the pathological cords in Dupuytren's disease.
Question 2 (5 marks)
What are the risk factors, associations, and clinical features?
Question 3 (6 marks)
Describe the surgical technique for fasciectomy.
Question 4 (5 marks)
What are the treatment options and their indications?
Question 5 (4 marks)
What are the complications and how do you manage them?
Question 6 (4 marks)
Discuss the prognostic factors and recurrence.
Exam Day Cheat Sheet
Must Mention
- •Spiral cord displaces NV bundle centrally/superficially
- •Table-top test (Hueston)
- •Surgery: MCP >30°, PIP >20°
- •Fasciectomy = gold standard, lowest recurrence
- •Diathesis = bilateral, ectopic, family, young, male
- •PIP = worse prognosis
Common Pitfalls
- •Forgetting spiral cord
- •Wrong surgical threshold
- •Missing diathesis
- •Wrong recurrence rates
- •Missing PIP prognosis
- •Confusing extension vs recurrence