EpistemisDupuytren's contracture
Specialty: Musculoskeletal.
Why it occurs
- Proliferative thickening and shortening of the palmar fascia (type III collagen replaces type I)
- Genetic predisposition (northern European origin, autosomal dominant inheritance with variable penetrance)
- Repetitive occupational microtrauma or use of vibrating tools
- Diabetes mellitus type 1 and 2
- Chronic alcohol consumption or liver cirrhosis
- Epilepsy (possible relationship with prolonged treatment with phenobarbital)
Initial workup
Physical examination (positive Hueston table test due to not being able to rest the palm flat on a table) | Palmar high-resolution ultrasound (assesses the thickness of the fascial bands and the presence of fibroproliferative nodules).
red flags
Severe contracture of the fourth and fifth fingers in fixed flexion that completely prevents the opening of the hand for basic hygiene, producing dermoepidermal maceration and severe fungal or bacterial skin superinfection.
Standard management
- Intralesional injection of Clostridium histolyticum collagenase — enzyme that lyses the collagen cords of the palmar fascia, allowing assisted passive extension after 24-48 hours; requires application by trained specialist
- Triamcinolone acetonide infiltration — 40 mg/ml directly in painful active nodules in early phases
- Paracetamol for post-extension procedure pain.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3