MSK: Dupuytren's Contracture: Free MSRA Podcast

⚕️FREE MSRA PODCAST –Dupuytren’s Contracture🎧 A clear, high-yield breakdown of this progressive hand deformity causedby palmar fascia thickening – perfectfor exam prep and real-life clinical scenarios. 🧠Key Learning Points📌Definition• Dupuytren’scontracture is a progressive hand condition where thickening and tightening ofthe palmar fascia causes nodules, cords, and fixed flexion of the fingers,especially the ring and little fingers.📌Causes & RiskFactors• Strong geneticpredisposition (family history)• Male gender (6xmore likely than females)• Increasing age(typically over 50)• Northern Europeanancestry (“Viking disease”)• Smoking (triplesrisk)• Alcoholconsumption (especially dependence)• Diabetes (up to 1in 5 affected)• Repetitive handtrauma or vibration (occupational)• Raised bloodlipids• Epilepsy andphenytoin useMnemonic: Agingnorthern men smoking drinks sweetly (age, ancestry, male, smoking,alcohol, diabetes)📌Pathophysiology• Myofibroblastproliferation in palmar fascia• Excess collagendeposition leads to fibrosis• Formation ofpalmar nodules → cords → contractures• Fingers (mainlyring/little) pulled into flexion• Can affectknuckles (Garrod’s pads), soles (Ledderhose), rarely penis (Peyronie’s)📌Symptoms• Painless, firmnodules in the palm• Thickened cordsextending to fingers• Progressiveinability to fully extend affected fingers• Most commonlyaffects ring and little fingers• Skin dimpling orpuckering• Loss of handfunction (difficulty placing hand flat, shaking hands, gripping)Mnemonic: Ringand little like to twirl (contracture)📌DifferentialDiagnosis• Trigger finger• Osteoarthritis,rheumatoid arthritis• Tendonitis• Callus or ganglioncyst• Giant cell tumourof tendon sheath• Epithelioidsarcoma• Ulnar nerve palsy(claw hand)• Other handdeformities (swan neck, boutonniere)📌Diagnosis• Primarily clinical– history and physical exam• Tabletop test:inability to place palm flat on a table• Assess contractureangle at MCP and PIP joints• Bloods/imagingonly if investigating risk factors (e.g. diabetes, alcohol)Tip: “Vikinghand, clinical diagnosis – think tabletop test!”📌Management• Mild/early:observation, hand therapy, splinting (controversial)• Steroid orcollagenase injections into cords• Low-doseradiotherapy (for early disease, not routine)• Surgery formoderate/severe contracture: – Fasciotomy (cutcord) – Fasciectomy(remove diseased fascia)• Needleaponeurotomy (less invasive, higher recurrence)• Post-op rehab:physio/hand therapy crucial• Amputation (rare,for severe/complex cases)• Address modifiablerisk factors (smoking, alcohol)📌Complications• Progressive lossof hand function• Recurrentcontracture (esp. after less invasive treatment)• Surgical risks:nerve/vessel injury, infection, stiffness, chronic pain• Rare: secondarycancer after radiotherapy📌Prognosis• Most casesgradually progress, but up to 10% may stabilise or regress• Recurrence aftertreatment is common• Early onset,bilateral disease, or involvement of non-ring/little fingers predicts worseoutcome 📎More MSRA Resourcesfor Dupuytren’s Contracture📝 Revision Notes: https://www.passthemsra.com/topic/dupuytrens-contracture-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/dupuytrens-contracture-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/dupuytrens-contracture-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/dupuytrens-contracture-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/quizzes/dupuytrens-contracture/ #MSRA #MSRARevision#MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQandANotes#MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision#MSRARevisionWebsite #DupuytrensContracture