Clinical features

Typically a patient with Dupuytren's contracture is a middle-aged man with difficulties in carrying out activities at the workplace (manual labour, wearing gloves) and at home (washing, dressing). Clinical features are as follows:

• earliest manifestation seen in a patient is the thickening or pitting of the palmar skin (1)
• recognition of a firm painless nodule fixed to skin and deeper fascia is important for the early diagnosis of the disease (1).
  • nodules occur on the palms or fingers
  • palmar nodules – present near to the distal crease of the palm, often in line with the ring and small fingers or proximal to the bottom of the thumb and small finger.
  • digital nodules – seen near the proximal interphalangeal joint or at the base of the digit (2)
  • they are often painless, but with enlargement may cause pain (2)
  • classically nodules appears before the development of the cords (1)
• the thickening gradually extends distally to involve the ring or little finger and with time (may be months or several years) these cords gradually contract leading to progressive digital flexion deformities (1)
• the patient may complain of pain but this is seldom a principal feature
• there are often bilateral lesions (in UK 17% of cases) (3), however one hand is usually more severely involved more than the other (4)
• on examination, there may be flexion deformities of the metacarpophalangeal and proximal interphalangeal joints
• the knuckle pads may be thickened - Garrod's pads
• there may be similar nodules on the soles of the feet or Peyronie's diseas

Reference:

• (1) Townley WA et al. Dupuytren's contracture unfolded. BMJ. 2006;332(7538):397-400
• (2) Rayan GM. Dupuytren disease: Anatomy, pathology, presentation, and treatment. J Bone Joint Surg Am. 2007;89(1):189-98
• (3) British Society for Surgery of the Hand (BSSH). BSSH Evidence for Surgical Treatment 1. Dupuytren’s disease
• (4) Trojian TH, Chu SM. Dupuytren's disease: diagnosis and treatment. Am Fam Physician. 2007;76(1):86-9