Dupuytren's Contracture
NHS Tayside RefGuide
Warning
Who to refer
People wishing to consider surgery with:
- Contracture or significantly reduced handed function. Those who cannot put hand flat on a table.
- If fixed contracture 15° at PIP joint, or 15-30 ° MCP joint refer for opinion on surgery.
Who not to refer
- Tendon thickening/nodules only
- Not affecting hand function (able to place hand flat on table).
How to refer
- SCI Gateway/Hand Surgery. Patient may be appointed to Advanced Practitioner initially.
- Please include photograph showing contracture.
Symptoms and signs
- Common
- Usually arises in middle age or later
- More common in men than women.
- May be genetic, or associated with diabetes, smoking, alcohol or previous trauma
- Characterised by lumps, pits, cords and nodules in palmar/fingers
- Finger flexion contracture develops over months/years
- Nodules over back of the PIP joints (Garrod's pads)
- Not usually painful
- No cure.
For information if patients ask about treatments:
- Steroid injections: These may help with local tenderness, but have no significant effect on the disease and are therefore not recommended.
- Xiapex(Collagenase) injection: This drug has now been withdrawn from the market for treatment of Dupuytren's.
- Radiotherapy: Radiotherapy is an experimental treatment offered in some research centres. It is NOT available on the NHS on Scotland.
Initial management
Advice and information:
- Palmar nodule only: no active treatment required
- NO role for MSK Physiotherapy.