Hand / Fingers
Dupuytren's Contracture
뒤퓌트랑 구축
Progressive contracture from fibrosis of the palmar fascia preventing finger extension
- How common
- 4–6% of adults of Northern European descent
- Typical age
- Men, age 50+
What is it?
Palmar fascia fibroblasts proliferate and deposit type III collagen, forming contractile cords.
Commonly affected: Ring and little fingers most common; ulnar palm
How it develops
- Proliferative PhaseFibroblast proliferation, nodule formation
- Involutional PhaseMyofibroblasts align and produce collagen
- Residual PhaseMature fibrotic cord forms
- Joint ContractureCord shortens causing MCP/PIP flexion contracture
Symptoms
- Extension deficitMCP/PIP flexion contracture
- Fibrous cordPalpable band running from palm to finger
- Positive tabletop testCannot lay palm flat on table
- Palmar noduleFirm subcutaneous lump, usually painless
- Skin pittingSkin pits near palmar creases
How it is examined
- Nodule/cord palpationFirm palmar nodule and cord palpable
- Hueston tabletop testPositive when hand cannot lie flat
- Joint angle measurementMeasure MCP/PIP/DIP flexion contracture
- Garrod's pads checkPIP dorsal knuckle pads (Dupuytren diathesis)
Imaging
X-ray usually normal — diagnosis is clinical.
- Normal findings
- Normal joints
- Excludes other pathology
MRI/US can show palmar fascia thickening/nodules; not routinely required.
- Palmar fascia thickening
- Low-signal fibrotic cord (T1/T2)
- Nodule confirmation
Non-surgical care
- Observation (early)Monitor if no functional limitation
- Stretching/splintingExtension stretching and night splint
- Collagenase injection (CCH)Enzymatic dissolution of cord
- Needle aponeurotomy (NA)Needle division of cord to release
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
MCP contracture >30°, PIP >15°, positive tabletop test
Procedures that may be discussed
- Limited fasciectomy
- Dermofasciectomy
- Contracture release
Outlook
High recurrence (20–50% within 5 years); early treatment yields good function.