Dupuytren’s contracture

219 Dupuytren’s contracture



Instruction


Look at this patient’s hands.



Salient features



History




• Family history (there is a genetic predisposition)


• Cigarette smoking (J Bone Joint Surg 1997;79B:206–10)


• Alcohol intake (Arch Intern Med 1977;129:561–6)


• Chronic antiepileptic medications


• Systemic conditions: cirrhosis, diabetes, TB, epilepsy.



Examination




• Thickening of the palmar fascia, particularly along the medial aspect (feel for thickening before you comment on it).


• In almost all cases, the fourth finger is affected with associated involvement of fifth, third and second fingers in decreasing order of frequency (Fig. 219.1).


• Perform the Hueston tabletop test: if the patient is unable to lay his or her palm flat on a tabletop, the test is positive.


• Tell the examiner that you would like to:


• check the feet for contracture of the plantar fascia (Fig. 219.2)

• look for signs of alcoholism and cirrhosis.

image

Fig. 219.1 Duputryen’s contracture.


image

Fig. 219.2 Ectopic deposits. (A) Bilateral medial plantar and medial great toe involvement. (B) Right foot involvement.


(With permission from Canale, Beaty 2007.)



Diagnosis


This patient has Dupuytren’s contracture (lesion) associated with chronic alcoholic liver disease (aetiology) and has developed disabling contractures (functional status). Be prepared to grade Dupuytren’s contracture (see below).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Dupuytren’s contracture

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