V./4.: Dupuytren`s contracture

V./4.: Dupuytren’s contracture
V.4.1.: Definition
Dupuytren’s contracture is a disease involving the progressive shrinking of the palmar
aponeurosis leading to limited motion in the fingers. The disease is caused by the myofibroblastic
remodelling of the palmar aponeurosis, and contracture of the elements.
V./4.2.: Diagnosis
The palmar aponeurosis reaches from the distal wrist crease to the distal interphalangeal joints of
the fingers. The disease is classified according to the extent of the contracture.
0 = No alteration
N = Palpable lesion in the palm without flexion contracture
1 = Flexion deformity of the joints is between 0-45 degrees.
2 = Flexion deformity of the joints is between 45-90 degrees.
3 = Flexion deformity of the joints is between 90-155 degrees.
4 = Flexion deformity of the joints more than 90-155 degrees.
V./4.3.: Treatment
Treatment of the disease is surgical. If the disease only causes contractures in the MP joints
percutaneous fasciotomy may be performed at the distal palmar crease, as the nerve-blood vessel
bundle runs below the aponeurosis at this height.
If shrinking of the aponeurosis progresses significantly resection of the aponeurosis in the affected
ray should be performed. The procedure involves careful preparation of the s, and excising the
shrunken tissues.
Figure 1.: 4th degree Dupuytren’s contracture
Figure 2.:Surgical aponeurectomy