What are the clinical findings in an adult with a palpable Dupuytren’s cord causing metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint contracture?

Clinical Findings in Dupuytren's Contracture

The hallmark clinical finding is a palpable cord in the palm or digit that causes progressive flexion contracture, most commonly affecting the ring and small fingers at the MCP and PIP joints. 1, 2

Primary Clinical Features

Palpable Cord

• The cord is a firm, rope-like structure lying parallel and superficial to the flexor tendons, extending from the palm into the affected digit 1
• The cord is hypocellular and composed of dense collagen, feeling similar to tendon consistency on palpation 1
• Two-thirds of digital cords contain nodules—localized hypercellular collections that often co-localize with the PIP joint 2

Nodules

• Nodules appear as subcutaneous masses, typically at the level of the distal palmar crease 1
• These nodules are mostly cellular (myofibroblast-rich) and have a firmer consistency than surrounding tissue 1, 2
• Nodules contain the highest concentration of alpha-smooth muscle actin-positive cells (mean 97%, 2374 cells/mm²) compared to surrounding cord tissue 2

Joint Contractures

MCP Joint Contractures:

• MCP joint contractures respond well to surgical treatment regardless of severity 3
• Even severe MCP contractures (>30°) typically resolve completely after fasciectomy 3

PIP Joint Contractures:

• PIP joint contractures are more problematic and correlate directly with surgical outcome 3
• Contractures <15° achieve 98.85% correction 3
• Contractures 15-30° achieve 97.62% correction 3
• Contractures >30° achieve only 75.52% correction, with mean residual deformity of 13.62° at 6 months 3
• Severe PIP contractures (>70°) may require two-stage surgical techniques with external fixation 4

Distribution Pattern

• The ring and small fingers are most commonly affected 5
• Non-nodular cords (34% of cases) correlate with significantly greater digital flexion contracture 2
• Nodules frequently co-localize with the PIP joint (36 of 38 PIP-marked samples showed this pattern) 2

Associated Findings

Skin Changes

• Skin pitting or dimpling overlying nodules or cords 5
• Dermato-pathologic changes in the overlying skin 5

Ectopic Manifestations

• Regional manifestations may include plantar fibromatosis (Ledderhose disease) or penile fibromatosis (Peyronie's disease) 5
• These ectopic findings suggest more aggressive disease (diathesis) 5

Clinical Pitfalls

Do not confuse with pseudo-Dupuytren's conditions:

• Trigger finger, flexor tenosynovitis, or other causes of digital contracture must be excluded through careful examination 5
• The presence of a palpable cord superficial to the flexor tendons distinguishes true Dupuytren's from these mimics 1, 5

Recognize two distinct clinical entities:

• Typical Dupuytren's disease versus atypical Dupuytren's contracture differ in presentation, treatment response, and prognosis 5
• Accurate distinction requires careful history, thorough physical examination, and understanding of disease pathophysiology 5

Assess PIP joint involvement carefully:

• PIP contracture severity is the single most important predictor of surgical outcome—optimal results occur when contracture is between 15-30° 3
• Delaying surgery until PIP contracture exceeds 30° significantly worsens prognosis 3