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Dupuytren's Contracture M72.0 728.6

Dupuytren's Contracture Picture

synonyms:Dupuytren's Contracture

Dupuytren's Contracture ICD-10

Dupuytren's Contracture ICD-9

  • 728.6

Dupuytren's Contracture Etiology / Epidemiology / Natural History

  • Autosomal dominant fibroproliferative disease with variable penetrance
  • Most common in Caucasians of Celtic descent
  • Men > women
  • Generally occurs in patients >50yrs old
  • autosomal dominant transmission with variable penetrance.
  • Has been linked human leukocyte antigen (HLA)-DR3. (Neumuller J, Clin Immunol Immunopathol. 1994;71:142)
  • Associated with: diabetes, smoking, chronic alcoholism, epilepsy, infection

Dupuytren's Contracture Anatomy

  • Retrovascular cords may displace digital nerves superficially and toward the center of the digits generally at the level of the metacarpophalageal joints. (Rayan GM, Hand Clin 1999;15:73). Fascia deep to the neurovascular bundle forms the retrovascular cord.
  • Pretendinous cords are formed from pretendinous bands in the palms.
  • Natatory cords are formed from the natatory ligaments in the palm.
  • Central cords are formed from the volar superficial fascia in the digits.
  • Lateral cords are formed from the lateral digital sheets in the digitis.
  • Spiral cord arises from the lateral digital sheet, the pretendinous ligament, the spiral band, and the Grayson ligament.

Dupuytren's Contracture Clinical Evaluation

  • palmar nodule and cord adherent to the skin
  • flexion contracture
  • may have pitting over the nodule

Dupuytren's Contracture Xray / Diagnositc Tests

  • Imaging studies are normal.

Dupuytren's Contracture Classification / Treatment

  • Consider Xiaflex.  CPT 20527: injection, enzyme, palmar fascial cord.  CPT 26341: manipulation, palmar fascial cord, postenzyme injection.
  • Treatment options: needle aponeurotomy (26040), collagenase injection (20527, Xiaflex), total or limited  fasciectomy (26123).  Full thickness Skin grafts are beneficial for severe, diffuse disease and recurrences.
  • Collagenase injections: best for low severity, MP joint contractures . Patients should have well defined, palpable cord. Contra-indicated in patients on anticoagulation. Has been shown to improve ROM from 43.9º to 80.7º, versus, 45.3º to 49.5º for placebo. (Hurst LC,  N Engl J Med.2009;361:968)

Dupuytren's Contracture Associated Injury / Differential Diagnosis

  • trigger finger
  • stenosing tenosynovitis
  • ganglion cyst
  • soft-tissue mass

Dupuytren's Contracture Complications

  • tendon rupture
  • digital nerve injury
  • recurrence
  • lymphatic reaction (collagenase injections)
  • flexion contracture
  • hematoma
  • skin sloughing
  • infection
  • edema
  • CRPS

Dupuytren's Contracture Follow-up Care

  • Post op splint in extension and begin range-of-motion exercises within one week with occupational therapy.
  • Continue splinting for 6 weeks, followed by night splintgin for 3 months.

Dupuytren's Contracture Review References

  • Hall PN, Fitzgerald A, Sterne GD, Logan AM. Skin replacement in Dupuytren's disease. J Hand Surg Br. 1997 Apr;22(2):193-7. 
  • Heuston JT. The control of recurrent Dupuytren's contracture by skin replacement. Br J Plast Surg. 1969 Apr;22(2):152-6.
  • MCCASH CR. THE OPEN PALM TECHNIQUE IN DUPUYTREN'S CONTRACTURE. Br J Plast Surg. 1964 Jul;17:271-80.
  • Roush TF, Stern PJ. Results following surgery for recurrent Dupuytren's disease. J Hand Surg Am. 2000 Mar;25(2):291-6.  
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