Dupuytren's Contracture

This contorted hand of a 49-year-old man demonstrates Dupuytren's contracture, a disorder first described by Baron Guillaume Dupuytren in 1831. Although the condition may occur as a completely independent abnormality, it is commonly associated with chronic liver disease, diabetes mellitus, epilepsy, palmar fasciitis, carpal tunnel syndrome, rheumatoid arthritis, pulmonary tuberculosis, and alcoholism. This patient had a history of alcohol abuse.

Contractures are the result of fibrosis of periarticular strictures and shortening of muscles and tendons. Contracture of the palmar fascial bands produces flexion contracture of the metacarpophalangeal and proximal interphalangeal joints, the flexor tendon apparatus, and the skin itself. Dupuytren's contracture may affect one or both hands; if unilateral, the right hand is more commonly involved.

Some familial association has been identified. Men are far more likely to suffer from this ailment than women. Dupuytren's contracture may arise as a late sequela to reflex sympathetic dystrophy (see page 896) following myocardial infarction or shoulder immobilization.

Medical therapies are largely ineffective; surgery may be the only beneficial therapeutic option. Subcutaneous fasciotomy, or limited or radical fasciectomy, and amputation may be considered.