Dupuytren's Contracture
Dupuytren's Disease is a fibroproliferative disorder of the palmar fascia. It causes thickening and shortening of fibrous bands, leading to flexion deformities of the fingers (Ring and Little fingers most common).
1. Pathology
- Cell: Myofibroblast (Contractile cell).
- Progression: Nodule (Stage 1) -> Cord (Stage 2) -> Contracture (Stage 3).
- Risk Factors: "Viking Disease" (Northern European descent), Alcohol, Diabetes, Epilepsy medications (Phenytoin), Smoking.
2. Clinical Features
- Deformity: Fixed flexion of MCP and PIP joints.
- Table Top Test: Patient cannot place palm flat on a table. (Indication for surgery).
3. Management
- Non-Surgical: Needle Aponeurotomy (percutaneous release) or Collagenase injection (Xiaflex).
- Surgical:
- Fasciectomy: Removal of diseased fascia (Gold standard).
- Dermo-fasciectomy: Removal of skin and fascia + Skin grafting (Lowest recurrence).
25 Practice MCQs
Q1. The primary cell responsible for contraction in Dupuytren's is:
Answer: B). Contains actin filaments allowing contraction.
Q2. Which fingers are most commonly involved?
Answer: A). Ulnar side of hand.
Q3. The "Table Top Test" is positive when:
Answer: A). Indicates MCP flexion > 30 degrees. Usually warrants intervention.
Q4. Dupuytren's Diathesis implies:
Answer: A). Associated with high recurrence.
Q5. Garrod's Pads are found on:
Answer: A). Ectopic deposit of Dupuytren's.
Q6. Ledderhose Disease affects:
Answer: A). Plantar fibromatosis.
Q7. Peyronie's Disease affects:
Answer: A). Causes curvature; associated with Dupuytren's.
Q8. Which nerve is at risk during surgery?
Answer: A). Spiral cords can wrap around the digital nerve.
Q9. Collagenase (Xiaflex) injection works by:
Answer: A). Clostridium histolyticum collagenase.
Q10. Post-op Splinting is usually in:
Answer: A). To maintain the length gained by surgery.
Q11. Is Dupuytren's painful?
Answer: B). Functional impairment is the main issue.
Q12. The Spiral Cord causes:
Answer: A). Makes surgery dangerous as nerve position is altered.
Q13. Skin grafting (Dermo-fasciectomy) has the advantage of:
Answer: A). Recurrence is rare under a graft.
Q14. Which structure is NOT involved in Dupuytren's?
Answer: A). Tendons are normal; the fascia overlying them is diseased.
Q15. Z-plasty is used to:
Answer: A). Standard closure technique.
Q16. "Open Palm" technique (McCash) involves:
Answer: A). Reduces hematoma risk and pain.
Q17. Recurrence rate after fasciectomy is approx:
Answer: A). It is a progressive disease.
Q18. Risk factors include consumption of:
Answer: A). Lifestyle factors matter.
Q19. Can splinting alone cure the contracture?
Answer: B). Splinting cannot stretch the mature collagen cord.
Q20. Needle Aponeurotomy (NA) is best for:
Answer: A). Higher recurrence but quick recovery. Riskier at PIP due to nerve position.
Q21. Central Cord causes:
Answer: B). Attaches to middle phalanx.
Q22. Natatory Cord causes:
Answer: A). Tightness between fingers.
Q23. Post-op Flare Reaction involves:
Answer: A). Common in women; managed with steroids/therapy.
Q24. Is Dupuytren's associated with manual labor/vibration?
Answer: A). Recognized as an occupational disease in some countries.
Q25. Radiotherapy is used for:
Answer: A). Can stop the active phase.
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