Dupuytren's Disease

Dupuytren's disease is a fibroproliferative disorder of the palmar and digital fascia that forms nodules and cords and can pull the fingers into fixed flexion.

It is common, more so in men, people of Northern European descent and those with a family history. In a meta-analysis of Western populations, prevalence was about 12% at 55, 21% at 65 and 29% at 75.

Most disease progresses slowly over years. Treatment is guided by contracture and function, not by the presence of nodules, and no treatment cures it.

The palmar aponeurosis sends longitudinal pretendinous bands into each finger, continuous with the digital fascia. In Dupuytren's these bands become cords. The ring and little fingers are most often affected.

Myofibroblasts proliferate within the fascia, driven by TGF-beta signalling. Luck described 3 stages: proliferative (cellular nodules), involutional (myofibroblasts contract and collagen is laid down) and residual (acellular cords). Clinically the disease runs from nodule to cord to contracture of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.

Risk factors:

• •Male sex, increasing age and Northern European ancestry
• •Family history
• •Diabetes, smoking and high alcohol intake
• •It occasionally follows injury or surgery to the hand or wrist; it does not appear to be linked to manual work