Initial Presentation of Dupuytren's Contracture
Dupuytren's contracture typically begins with painless nodules in the palm, most commonly in the ulnar aspect (ring and small finger rays), appearing at the level of the distal palmar crease. 1
Early Clinical Findings
The disease presents with two characteristic lesions that develop sequentially:
- Nodules appear first in approximately 90% of cases, typically located in the ulnar part of the palm at the distal palmar crease 1
- These nodules are painless and represent the earliest detectable sign 2, 1
- The nodules are palpable, firm subcutaneous masses that adhere to the overlying skin and underlying structures 3, 4
- Cords develop later, appearing as fibrous bands that run parallel and superficial to the flexor tendons, eventually causing progressive finger contracture 3, 5
Age and Laterality Patterns
- The disease most commonly starts in the right hand 1
- Peak onset occurs between ages 40-59 years in men and 40-69 years in women 1
- In approximately 10% of bilateral cases, the disease starts simultaneously in both hands 1
- Rare cases can present before age 10, though this is exceptional 1
Associated Clinical Context
When evaluating a patient with these findings, consider the broader clinical context:
- Dupuytren's contracture may be a sign of alcoholic liver disease, particularly when seen alongside other stigmata such as bilateral parotid gland hypertrophy, muscle wasting, malnutrition, gynecomastia, or spider angiomata 6
- The presence of Dupuytren's contracture in patients with suspected harmful alcohol consumption should prompt screening for alcoholic liver disease 6
Imaging Characteristics at Presentation
If imaging is performed early in the disease course:
- Ultrasound shows hypoechoic bands adhering to the flexor tendons and deep dermis surface, which is pathognomonic 4
- Early nodules appear hypoechoic and hypervascular on ultrasound with Doppler 4
- MRI reveals nodules with intermediate signal intensity (similar to muscle) on both T1- and T2-weighted images, often stippled with focal areas of lower signal intensity, reflecting their cellular nature 3
Critical Distinction from Other Contractures
Do not confuse Dupuytren's contracture with neurological contractures (such as post-stroke), which present differently with associated spasticity, sensorimotor deficits, and typically affect the hemiplegic side following a clear neurological event 7, 8. Dupuytren's is a primary fibrosing disorder of the palmar fascia, not a consequence of neurological injury.