DUPUYTREN'S CONTRACTUREThis relatively common disorder is characterized by hyperplasia of the palmar fascia and related structures, with nodule formation and contracture of the palmar fascia. The cause is unknown, but the condition has a genetic predisposition and occurs primarily in white men over 50 years of age. The incidence of Dupuytren's contracture is higher among alcoholics and patients with chronic systemic disorders (eg, cirrhosis, diabetes, epilepsy, tuberculosis). The onset may be acute, but slowly progressive chronic disease is more common. Dupuytren's contracture manifests itself by nodular or cordlike thickening of one or both hands, with the fourth and fifth fingers most commonly affected. The patient may complain of tightness of the involved digits, with inability to satisfactorily extend the fingers, and on occasion there is tenderness. The resulting functional and cosmetic problems may be extremely disabling. Fasciitis involving other areas of the body may lead to plantar fibromatosis (10% of patients) or Peyronie's disease (1-2%). Periodic examination of patients in early stages of disease is recommended. If the palmar nodule is growing rapidly, injections of triamcinolone into the nodule may be of benefit. Surgical intervention is indicated in patients with significant flexion contractures, depending on the location, but recurrence is not uncommon. |
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