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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°).
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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