Don't Give Dupuytren's Contractures the Upper Hand

Author

Jesse Dashe MD
September 04, 2023

Greetings colleagues,

Welcome to the Hands-On The East Bay Newsletter, which summarizes key topics in hand surgery for providers on the front lines. I'm Dr. Jesse Dashe, an orthopedic hand surgeon at the East Bay Hand Medical Center.

As we know, Dupuytren's contracture is a progressive fibroproliferative disorder of the hand. Let's review some key aspects in evaluating and treating this condition.

Question:

What are the most common initial symptoms?

Answer: 

Early on, patients may notice nodules or cords in the palm. Pits or dents can also develop in the palm when extending the fingers.

Dupuytren’s Contracture. Source: Orthobullets

Question:

What are keys to the physical exam?

Answer: 

Examine for:

  • Palpable nodules, cords, or bands in palm/fingers

  • Contracture of fingers, especially ring/little

  • Degree of flexion contracture

Question:

When should patients be referred to a hand specialist?

Answer: 

Refer patients who have:

  • Inability to place hand flat on a table ("positive tabletop test")

  • Contractures

  • Recurrent disease or rapid progression

  • Functional impairment from contractures

Table Top Test. Source: Orthobullets

Question:

What are the current treatment options?

Answer: 

  • Collagenase injection

  • Needle aponeurotomy

  • Fasciectomy (surgery) - lowest recurrent rate

s/p fasciectomy. Source: Orthobullets

Please feel free to reach out if you have any questions or would like to refer any patients. You can refer patients at handreferral.com or by using this link:

If you need to reach me directly, please respond to this email or email me at [email protected].

Please contact me so I can come by your facility to meet face-to-face and/or give presentations, splinting sessions, etc.

Lastly, let me know if you have any other hand topics you would like covered in the future!

Sincerely,