Dupuytren’s diseaseBMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1308 (Published 04 June 2021) Cite this as: BMJ 2021;373:n1308
- Marta Karbowiak, clinical fellow in orthopaedics1,
- Thomas Holme, trauma and orthopaedics registrar2,
- Kamran Khan, general practitioner3,
- Arvind Mohan, consultant orthopaedic and upper limb surgeon4
- 1Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
- 2Epsom Hospital, Epsom KT18 7EG, UK
- 3Stovell House Surgery, Croydon CR0 6AH, UK
- 4Croydon Health Services NHS Trust, Croydon CR7 7YE, UK
- Correspondence to: M Karbowiak
What you need to know
Assess the impact of Dupuytren’s disease on activities of daily living—work, hobbies, personal grooming
With national restrictions to elective surgery and withdrawal of collagenase injections in Europe, the management of the condition is likely to change over the coming years
Operative management does not always lead to resolution of symptoms—postoperative stiffness is common, and rates of recurrence can be high
Dupuytren’s disease is a common condition of the hand affecting the palmar fascia. Initially, it manifests as pitting or thickening of skin over the palm. Later on, it can develop into nodules or cords that act as the powerhouse of the disease. These can then progress to contractures manifesting as flexion deformities of fingers (fig 1). The contracture can span across metacarpophalangeal and interphalangeal joints, most commonly affecting the ring and little fingers.1 Rates of prevalence vary greatly depending on the population group and study design.2 It is estimated that the condition affects between 3% and 5% of the UK population,3 but the exact numbers vary significantly between age groups and geographical locations.
In the UK and in other settings, eligibility criteria for the management of Dupuytren’s disease may vary,4 both in the community and in secondary care. This clinical update provides a summary of the latest evidence on operative and non-operative treatments including an overview of current guidelines.
What do we know about causes and risk factors?
The exact cause of Dupuytren’s disease is unknown, although microvascular angiopathy has been suggested as a possible underlying mechanism.5 There is a strong genetic association, with one study finding 80% heritability.6 It is more common in northern Europeans, with highest rates of prevalence in Icelandic and Scandinavian populations.7 The age of first presentation is usually between 50 and 70 years old, …