Dupuytren's

Dupuytren's contracture occurs when the connective tissue (fascia) in the palm and fingers thickens into nodules and cords. It can result in finger contractures

Assessment

Dupuytren's typically presents with some of the following:

  • Skin thickening or pitting in the palm
  • Firm nodules that can be tender and inflamed in the early stages
  • Fibrous, tendon-like cords
  • Contractures of the cords:
    • flexion deformity at the metacarpophalangeal / interphalangeal joints
    • confirmed if the person is unable to lay their hand flat on a table top
  • One or both hands may be affected
  • The ring finger is most commonly affected, followed by little and middle fingers
  • he thumb and index fingers are usually spared
  • Family history often positive

Investigations

Clinical diagnosis

Management

Any MCPJ contracture of 30 degrees or more, or PIPJ or DIPJ contracture of 20 degrees or more needs referral to a hand surgeon for treatment

For all other patients:

  • Provide explanation of the condition and advice; this can be a progressive, but benign disease, with finger contractures developing later
  • No treatment is necessary whilst there are no contractures
  • Reassure that tender nodules will become less tender over time
  • Advise the person to return when they cannot flatten their outstretched hand

Splinting and corticosteroid injections are not of benefit

Referral

Referral Criteria

Refer to Hand Clinic

The CCG will fund treatment for Dupuytren's Contracture where there is:

  • An MCPJ contracture of 30 degrees or more, or a PIPJ or DIPJ contracture of 20 degrees or more
  • Bulky palmar nodules resulting in significant impairment of hand function (defined as a loss or absence of an individual's capacity to meet personal, social or occupational demands).
  • Treatment options include needle fasciotomy (percutaneous division of cords under local anaesthetic), collagenase injections, and open surgery.

(For further information see link to the local commissioning policy)

Referral Instructions

Refer to the Hand Clinic (Orthopaedics)

Please refer using the e-Referral Service

  • Specialty: Orthopaedics
  • Clinic Type: Hand and Wrist
  • Service: DRSS-South Devon & Torbay-Orthopaedics-Hand & Wrist-Devon CCG - 15N

Referral Forms

DRSS Referral form

Torbay and South Devon seeking advice form

Supporting Information

GP Information

South Devon and Torbay CCG Dupuytren's Contracture Treatment commissioning policy

Patient information

MyHealth patient information - Dupuytrens

Dupuytren's Contracture patient information

Pathway Group

This guideline has been signed off on behalf of South Devon and Torbay CCG.

Publication date: March 2017

 

Home > Referral > SDevon & Torbay > Musculoskeletal & Joint Disorders > Dupuytren's

 

  • First line
  • Second line
  • Specialist
  • Hospital