From the Research
The workup for Dupuytren's contracture primarily involves a thorough clinical examination, as the diagnosis is typically made based on physical findings alone. The physician should assess for characteristic nodules and cords in the palmar fascia, measure the degree of finger contracture using a goniometer, and perform a tabletop test (inability to lay the hand flat on a table indicates positive disease) 1. Functional assessment should evaluate the impact on daily activities. While imaging is not routinely necessary, in complex or atypical cases, ultrasound or MRI may help differentiate Dupuytren's from other conditions. Laboratory tests are generally not indicated unless there are concerns about associated conditions like diabetes. Documentation should include photographs of hand positioning and measurements of contracture angles to track disease progression over time. The workup should also include assessment of risk factors such as family history, Northern European ancestry, manual labor, smoking, alcohol use, diabetes, and seizure disorders, as these may influence disease progression and treatment planning.
Key Components of the Workup
- Clinical examination to assess for characteristic nodules and cords in the palmar fascia
- Measurement of finger contracture using a goniometer
- Tabletop test to evaluate the ability to lay the hand flat on a table
- Functional assessment to evaluate the impact on daily activities
- Imaging (ultrasound or MRI) in complex or atypical cases
- Laboratory tests (if concerns about associated conditions like diabetes)
- Documentation of hand positioning and contracture angles
- Assessment of risk factors (family history, Northern European ancestry, manual labor, smoking, alcohol use, diabetes, and seizure disorders)
Treatment Options
Treatment options for Dupuytren's contracture include surgery, needle fasciotomy, and collagenase injection, with surgery having superior success rates at 2 years compared to both needle fasciotomy and collagenase 1. The choice of treatment depends on the severity of the contracture, patient preference, and the potential risks and benefits of each option.
Recent Study Findings
A recent randomized controlled trial published in the Annals of Internal Medicine found that surgery had superior success rates compared to both needle fasciotomy and collagenase injection at 2 years, with success rates of 78% for surgery, 50% for needle fasciotomy, and 65% for collagenase 1. This study provides strong evidence for the effectiveness of surgery in the treatment of Dupuytren's contracture.