Dupuytren's contracture unfolded

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7538.397 (Published 16 February 2006)
Cite this as: BMJ 2006;332:397

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  1. W A Townley, research fellow (willtownley@hotmail.com)1,
  2. R Baker, research fellow1,
  3. N Sheppard, senior house officer3,
  4. A O Grobbelaar, consultant plastic surgeon2
  1. 1 RAFT Institute of Plastic and Reconstructive Surgery, Mount Vernon Hospital, Northwood HA6 2RN
  2. 2 Department of Plastic and Reconstructive Surgery, Mount Vernon Hospital
  3. 3 Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Slough SL2 4HL
  1. Correspondence to: W A Townley, 110 Sinclair Road, London W14 0NJ
  • Accepted 21 December 2005

Introduction

Dupuytren's disease is a common and disabling fibroproliferative condition of the hand. It tends to strike patients in advancing age, causing progressive digital flexion contracture. Through its many associations, Dupuytren's disease crosses all borders of medicine and is often encountered by surgeon, physician, and general practitioner alike. To the medical student, it is dependable examination fodder—a name on many lists and a sign of many systems.

The early history of Dupuytren's disease lies in folklore—it has been fabled somewhat contentiously for being a disease disseminated by the Vikings, an explanation for the curling of the papal “hand of benediction,” and a curse on the bagpipe craftsmanship of the MacCrimmon clan.1 The eminent surgeon Henry Cline introduced the condition into the medical literature and carried out the first surgical corrective procedures. The French surgeon Baron Dupuytren further developed Cline's observations and cemented his reputation by providing the eponym for the condition. We have reviewed the literature with the aim of highlighting important considerations in the management of patients with Dupuytren's disease, including a succinct overview of treatment options and referral guidelines.

Sources and selection criteria

We used PubMed and Medline search engines to identify seminal reviews, studies, and trials to clarify current knowledge of Dupuytren's disease. We used broad search terms to ensure that we identified all relevant papers. We cast the net further by scouring all reference lists to ensure that we omitted no important articles.

Presentation

Pitting and thickening of the palmar skin are the earliest manifestations of Dupuytren's disease. However, the key to early diagnosis is recognition of the nodule, a firm painless mass fixed to skin and deeper fascia. Classically, a nodule precedes development of a cord. Over time, which may be months or several years, the cord gradually contracts, reeling in the metacarpophalangeal joint and the proximal interphalangeal joint and …

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