What is Dupuytren's (Dupuytren) contracture?

From the Guidelines

Dupuytren's contracture is a significant condition that requires early intervention to prevent limitation of function, and its presence can also be an indicator of harmful alcohol consumption, which should be addressed through screening and brief intervention. When considering the management of Dupuytren's contracture, it is essential to recognize its potential association with alcohol-related liver disease (ALD), as highlighted in the EASL clinical practice guidelines 1. According to these guidelines, screening for harmful alcohol consumption should be done systematically in patients by their general practitioner (GP) and in patients admitted to emergency facilities, including those presenting with clinical signs suggestive of ALD, such as Dupuytren’s contracture 1. Some key points to consider in the management of Dupuytren's contracture and its potential link to ALD include:

• Early recognition and intervention for harmful alcohol consumption can reduce the risk of developing liver disease and other complications 1
• Screening for ALD should be undertaken in patients with clinical signs suggestive of harmful alcohol consumption or liver cirrhosis, including Dupuytren’s contracture 1
• Effective interventions for reducing ALD-related morbidity and mortality include pricing-based policies, regulation of availability, and bans on advertising and marketing of alcohol 1
• Patients identified through screening should undergo brief intervention and referral to a multidisciplinary team 1. In terms of treatment for Dupuytren's contracture, options may include needle aponeurotomy, collagenase injections, and surgical fasciectomy, depending on the severity of the condition. It is crucial to prioritize the management of harmful alcohol consumption in patients with Dupuytren's contracture, given the potential link between the two conditions and the importance of reducing ALD-related morbidity and mortality 1.

From the Research

Definition and Prevalence of Dupuytren's Disease

• Dupuytren's disease is a progressive condition that causes the fibrous tissue of the palmar fascia to shorten and thicken 2.
• The worldwide prevalence of Dupuytren's disease is 8% 3.
• It is common in men older than 40 years, persons of Northern European descent, and persons who smoke, use alcohol, or have diabetes 2.

Symptoms and Diagnosis

• Patients present with a small, pitted nodule (or multiple nodules) on the palm, which slowly progresses to contracture of the fingers 2.
• The disease can be diagnosed based on the presence of these nodules and the progression of contracture 2.

Treatment Options

• The disease initially can be managed with observation and nonsurgical therapy 2.
• Steroid injection into the nodule has been shown to reduce the need for surgery 2.
• Surgical referral should be made when metacarpophalangeal joint contracture reaches 30 degrees or when proximal interphalangeal joint contracture occurs at any degree 2.
• Limited fasciectomy is the most common treatment and is considered the reference standard 3.
• Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy 3.
• Collagenase Clostridium histolyticum (CCH) and percutaneous needle aponeurotomy (PNA) are also treatment options 4, 5.

Complications and Recurrence

• Possible complications of treatment include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6-39.1% for all complications taken together 3.
• The recurrence rate at 5 years is 12-73% 3.
• Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment 3.