Materiały źródłowe

• #1 Dupuytren Contracture – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/hand-disorders/dupuytren-contracture

  Dupuytren contracture is diagnosed primarily based on the clinical history and physical examination. The hallmark finding on physical examination early on is a puckering of the skin overlying the flexor tendon just proximal to the flexor crease of the finger on the palm, usually of the fourth or fifth finger. These findings typically progress and may develop into palpable nodules, skin tethering, and flexion contractures of the affected fingers. Imaging of the hand is generally not necessary. […] Dupuytren contracture is one of the more common hand deformities; the incidence is higher among men and increases after age 45.

• #1 Dupuytren’s Disease – Dupuytren’s Contracture – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/

  In many cases, a Dupuytren’s contracture progresses (gets worse) very slowly, over a period of years, and may remain mild enough that no treatment is needed. […] When this happens, treatment may be needed to help reduce the contracture and improve motion in the affected fingers. […] Your doctor will likely talk with you about your general health and medical history and ask about your symptoms. […] Your doctor will then examine your fingers and hand. […] During the exam, they will likely: Record the location of nodules and cords on your palm, Measure the range of motion of your fingers and thumb, Test the feeling in your fingers and thumb. […] These measurements may be compared with other measurements taken throughout your treatment to determine whether the condition is progressing (getting worse) over time.

• #1 Diagnosis and indications for surgical treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/1769986/

  Dupuytren’s disease is a common problem in most hand surgery practices. It is usually easily diagnosed by the presence of its primary palmar manifestations: the nodule, the cord, and the digital flexion contracture. […] The need and advisability of surgical intervention should be determined in close consultation with the patient after becoming thoroughly familiar with functional deficits and specific functional goals. A flexion contracture of more than 30 degrees at the MPJ or any contracture at the PIP is generally thought to be an indication for palmar fasciectomy. […] Patients should be aware of potential complications, those in higher risk categories should be identified preoperatively.

• #1 Dupuytren’s Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0701/p86.html

  Dupuytren’s disease can be distinguished from other causes of hand contracture because it begins as a nodule and slowly progresses to contracture of the fingers. […] The Hueston tabletop test can help with the diagnosis. If a patient is unable to lay his or her palm flat on a tabletop, the test is positive. […] Surgery should be performed in patients with Dupuytren’s disease when the metacarpophalangeal joint contracture exceeds 40 degrees or when the proximal interphalangeal joint contracture exceeds 20 degrees. […] Referral to a hand surgeon is indicated if the MCP joint contracture reaches 30 degrees or if PIP joint contracture occurs at any degree. […] The Hueston tabletop test is a good indication for referral. […] Timing of surgical intervention varies, but surgery is usually performed when the MCP joint contracture exceeds 40 degrees or when the PIP joint contracture exceeds 20 degrees.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosing-and-Treating-Dupuytrens-Contracture.aspx

  Dupuytren’s starts as a lump, or nodule, then slowly evolves to finger contracture. […] When examining patients, doctors should record the location of any nodules, as well as the existence of dimples, pitting of the skin, and tenderness. […] If a physician notes the presence of any contractures, they should record the angles of the contractures at the metacarpophalangeal joint, as well as at the proximal interphalangeal joint. […] The Hueston tabletop test should be used as part of the diagnosis. […] The diagnosis is positive if a patient is not able to place their fingers flat on a table. […] Doctors will determine the extent of the condition by applying a grading system. […] At grade 1, the condition appears as a thick lump, or nodule, and as a band in the muscles of the palm. […] This band, or stretched line, could evolve or lengthen, as well as cause some pitting of the skin to occur. […] Grade 2 appears as a band surrounding the tendon, impeding the ability to extend the affected finger. […] Grade 3 involves the inability to fully straighten the finger.

• #1 Dupuytren Contracture: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/329414-overview

  The ring finger is most commonly involved, followed by the fifth digit and then the middle finger. The index finger and the thumb are typically spared. […] Males are three times as likely to develop disease and are more likely to have higher disease severity. […] Therapies include conservative medical and surgical modalities. Although the condition is not fatal, significant morbidity can occur if patients are untreated. […] Dupuytren disease occurs in the following three stages: Proliferative phase, Involutional phase, Residual phase. […] A prospective study in 247 Dutch participants with primary Dupuytren disease with follow-up at intervals of 3 to 6 months found that in up to 75% of patients, the disease stabilizes or even regresses. […] The grading system for Dupuytren disease severity is as follows: Grade 1 – Thickened nodule and band in the palmar aponeurosis; may have associated skin abnormalities, Grade 2 – Development of pretendinous and digital cords with limitation of finger extension, Grade 3 – Presence of flexion contracture.

• #1 CoxHealth | Dupuytren Contracture

  https://www.coxhealth.com/condition/dupuytren-contracture/

  Your healthcare provider will examine your hand. They will test the flexibility and feeling in your thumb and fingers. Your grip and pinch strength may also be tested. […] Your healthcare provider will measure and record the locations of nodules and bands on your palm. Using a special tool, they will measure how much your fingers are curling or contracting. Range of motion in your fingers may also be measured. […] These measurements will be compared to later measurements to see if the disease gets any worse. They can also be used to see if treatment is working.

• #1 Dupuytren Contracture Differential Diagnoses

  https://emedicine.medscape.com/article/329414-differential

  Dupuytren disease must be distinguished from several other conditions that affect the hand, including trigger finger, stenosing tenosynovitis, a ganglion cyst, or a soft-tissue mass. […] Unlike Dupuytren contracture, trigger finger typically involves pain with flexion followed by the inability to extend the affected digit. […] Stenosing tenosynovitis may be distinguished from Dupuytren disease by pain and a history of overuse or trauma. […] A small, movable nodule that is tender to palpation at the MCP joint is likely a ganglion cyst. […] A soft-tissue mass must also be excluded from the diagnosis, especially if the patient is significantly younger than the typical patient with Dupuytren disease and if he or she has no other risk factors. […] A patient younger than age 40 years without involvement of the dorsal hand, foot, or penis is unlikely to have Dupuytren disease; however, the possibility of a sarcoma must be ruled out although the pathologic findings of a biopsy will most likely reveal a benign etiology (eg, lipoma, inclusion cyst).

• #1 Dupuytren Contracture: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16941-dupuytrens-contracture

  Dupuytren contracture is a genetic disorder that makes the tissue under the skin of your palms and fingers thicken and tighten. […] A healthcare provider will diagnose Dupuytren contracture with a physical exam of your hand. Theyll look at your hand and fingers, feel for nodules and cords under your skin and measure how severe your contracture may be. […] There arent any special tests used to diagnose Dupuytren contracture. Your provider may order blood tests or X-rays to check for other conditions that can affect your hands.

• #1 Dupuytren Contracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526074/

  Dupuytren contracture is a myofibroblastic disease that affects the hands. It usually results in painless cords that eventually lead to flexion contracture of the fingers. […] This activity reviews the evaluation and management of Dupuytren contracture and highlights the role of the healthcare team in evaluating and treating patients with this condition. […] Assess the physical examination findings associated with Dupuytren contracture. […] Dupuytren disease starts as a palpable nodule in the palm, usually at the distal palmar crease. The nodules enlarge into cords, and patients may present with palpable cords along the palm early in the disease. […] Physical findings of Dupuytren contracture include: Blanching of the skin when the finger is extended. […] Evaluation: X-rays of the hand are unnecessary but may be obtained to examine for bony abnormalities like arthritis that may contribute to the loss of range of motion. Additionally, laboratory workup to rule out diabetes is recommended. Ultrasound may demonstrate thickened palmar fascia and nodules.

• #1 Imaging for Dupuytren contracture

  https://www.hcplive.com/view/imaging-dupuytren-contracture

  In Dupuytren contracture, hyperplasia of the palmar aponeurosis induces a contracture that typically involves the fourth and fifth digits of the hand. […] The diagnosis is primarily clinical and is confirmed by pathology. […] Presentation in patients younger than 40 years is unusual, in which case an underlying condition, such as sarcoma, needs to be excluded with MRI. […] Imaging is not routinely required for Dupuytren contracture. However, MRI has a special role in defining palmar involvement. […] Thus, MRI is valuable in planning surgical treatment.

• #1 After Dupuytren’s Contracture Diagnosis: Treatment & Progression

  https://resources.healthgrades.com/right-care/bones-joints-and-muscles/what-to-expect-after-a-dupuytrens-contracture-diagnosis

  If you see contracture beginning, visit your doctor. Ideally, surgeons would like to begin procedures when your contracture is at an early stage, between 20 and 40 degrees. Contractures can be treated at any stage—even the most severe. However, treatment early on in the disease process has the most promise for a good outcome. Your doctor may suggest one of these most common treatments for Dupuytren’s contracture.

• #1 Dupuytren’s Contracture: What is it? Symptoms, Causes & Treatment | The Hand Society

  https://www.assh.org/handcare/condition/dupuytrens-contracture

  Before treatment, the hand surgeon will discuss realistic goals and possible risks. […] It is important to make sure the patient will understand this problem and both short- and long-term expectations. […] The main reason to undergo treatment is to increase your ability to straighten the finger.

• #1 Dupuytren’s contracture

  https://www.nhs.uk/conditions/dupuytrens-contracture/

  Dupuytren’s contracture does not usually need any treatment in the early stages. […] If it’s severe and you cannot straighten your fingers or use your hand normally, a GP may refer you to a specialist for treatment. […] The specialist will explain what the benefits and risks of each treatment option are. They’ll tell you what to expect afterwards, including advice on exercises to do. […] Your finger may not be completely straight after treatment, and might not be as strong and flexible as it used to be. […] The contracture could also come back after a few years. […] There are 3 main types of treatment: surgery to remove the affected tissue in the hand (fasciectomy), using a needle to make small cuts in the affected tissue (needle fasciotomy), surgery to remove the affected tissue and skin (dermofasciectomy). […] If you have Dupuytren’s contracture, you might be able to refer yourself directly to services for help with your condition without seeing a GP.

• #1 Dupuytren’s Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0701/p86.html

  A study showed that injections with tri-amcinolone acetonide (Kenalog) monthly for up to five months, or every six weeks for up to three injections, followed by a six-month respite, lead to significant disease regression. […] Surgery was needed in fewer patients who received injections than would be anticipated in patients receiving expectant management alone.

• #1 Dupuytren’s: Questions for and From Your Doctor

  https://www.webmd.com/a-to-z-guides/dupuytrens-disease-frequently-asked-questions

  The treatment you receive will depend on the location, stage, and severity of the disorder. In your initial consultation, your doctor will probably provide a brief overview of how Dupuytren’s is treated. A newer procedure uses enzyme injections to dissolve the tissue. This is usually used first as it is least invasive. In cases where contracture has progressed, surgery is the most common treatment. Another treatment method uses needles to break up affected tissue. […] As mentioned earlier, the recurrence rate of Dupuytren’s symptoms is high, so whatever treatment you have may need to be repeated. Recurrence rates are lower after surgery than after needle or enzyme procedures.

• #1 Dupuytren Contracture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526074/

  Indications for treatment are based on the effects of the disease on the patient’s quality of life. […] The management of Dupuytren contracture is done by an interprofessional team that may consist of a dermatologist, orthopedic/hand surgeon, hand therapist, and the patient’s primary care physician.

• #1 Dupuytren’s Disease – Dupuytren’s Contracture – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/

  If the contracture interferes with hand function, your doctor may recommend surgical treatment. […] The goal of surgery is to reduce the contracture and improve motion in the affected fingers. […] There is no known cure for Dupuytren’s contracture; however, surgery is intended to „set back the clock” by reducing the restricting (limiting) effect of the cords by either disrupting or removing them. […] Your doctor will talk with you about which procedure is best in your case. […] Dupuytren’s contracture typically progresses (gets worse) very slowly, over a period of years. […] Most patients have improved movement in their fingers after surgery. However, because the condition is not „cured” with surgery, about 20% of patients will experience a meaningful degree of contracture recurrence (the contracture comes back).

• #2 Dupuytren Contracture: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16941-dupuytrens-contracture

  Dupuytren contracture is a genetic disorder that makes the tissue under the skin of your palms and fingers thicken and tighten. […] A healthcare provider will diagnose Dupuytren contracture with a physical exam of your hand. Theyll look at your hand and fingers, feel for nodules and cords under your skin and measure how severe your contracture may be. […] There arent any special tests used to diagnose Dupuytren contracture. Your provider may order blood tests or X-rays to check for other conditions that can affect your hands.

• #2 Dupuytren contracture – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dupuytrens-contracture/diagnosis-treatment/drc-20371949

  In most cases, Dupuytren contracture can be diagnosed by the look and feel of the hands. Other tests are rarely necessary. […] Health care providers compare the hands with each other and check for puckering on the skin of the palms. They also press on parts of the hands and fingers to check for hard knots or bands of tissue. […] Another test for Dupuytren contracture involves putting the palm of the hand flat on a tabletop or other flat surface. Not being able to fully flatten your fingers means you might need treatment.

• #2 Dupuytren’s Contracture: What is it? Symptoms, Causes & Treatment | The Hand Society

  https://www.assh.org/handcare/condition/dupuytrens-contracture

  Symptoms of Dupuytrens contracture usually include lumps, nodules, and bands or cords on the palmar side of the hands. […] The disease may first be noticed due to difficulty in placing the hand flat on a surface or opening the hand fully. […] The presence of a lump in the palm does not mean that treatment is required or that the disease will progress. […] Therefore, it can be helpful to see a hand surgeon for an examination. […] Sometimes a history and examination is all that is needed to evaluate a mass. […] Other times, imaging such as an x-ray, ultrasound, or MRI may be indicated. […] A hand surgeon (either a trained orthopaedic surgeon, plastic surgeon, or a general surgeon) can discuss the most appropriate method based upon the stage and pattern of the disease and the joints involved.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosing-and-Treating-Dupuytrens-Contracture.aspx

  Dupuytren’s starts as a lump, or nodule, then slowly evolves to finger contracture. […] When examining patients, doctors should record the location of any nodules, as well as the existence of dimples, pitting of the skin, and tenderness. […] If a physician notes the presence of any contractures, they should record the angles of the contractures at the metacarpophalangeal joint, as well as at the proximal interphalangeal joint. […] The Hueston tabletop test should be used as part of the diagnosis. […] The diagnosis is positive if a patient is not able to place their fingers flat on a table. […] Doctors will determine the extent of the condition by applying a grading system. […] At grade 1, the condition appears as a thick lump, or nodule, and as a band in the muscles of the palm. […] This band, or stretched line, could evolve or lengthen, as well as cause some pitting of the skin to occur. […] Grade 2 appears as a band surrounding the tendon, impeding the ability to extend the affected finger. […] Grade 3 involves the inability to fully straighten the finger.

• #2 Dupuytren Contracture: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/329414-overview

  The ring finger is most commonly involved, followed by the fifth digit and then the middle finger. The index finger and the thumb are typically spared. […] Males are three times as likely to develop disease and are more likely to have higher disease severity. […] Therapies include conservative medical and surgical modalities. Although the condition is not fatal, significant morbidity can occur if patients are untreated. […] Dupuytren disease occurs in the following three stages: Proliferative phase, Involutional phase, Residual phase. […] A prospective study in 247 Dutch participants with primary Dupuytren disease with follow-up at intervals of 3 to 6 months found that in up to 75% of patients, the disease stabilizes or even regresses. […] The grading system for Dupuytren disease severity is as follows: Grade 1 – Thickened nodule and band in the palmar aponeurosis; may have associated skin abnormalities, Grade 2 – Development of pretendinous and digital cords with limitation of finger extension, Grade 3 – Presence of flexion contracture.

• #2 Dupuytren’s Contracture Portland | Dupuytren’s Contracture Disease Beaverton

  https://www.orthopedicandfracturespecialists.com/dupuytrens-contracture.html

  Diagnosis of Dupuytrens contracture is generally made entirely upon a physical examination. The physician will closely examine the hands and compare them to each other, checking for abnormalities. […] The physician will make a note of the location of the nodules and thick bands, measuring for the amount of contracture within the fingers and use these measurements throughout the treatment to study the progression of the disease.

• #2 Dupuytren Contracture Differential Diagnoses

  https://emedicine.medscape.com/article/329414-differential

  Conditions to consider in the differential diagnosis of Dupuytren contracture include the following: Diabetic cheiropathy, Epithelioid sarcoma, Fibroma, Giant cell tumor, Intrinsic joint disease, Lipoma, Neurofibroma, Palmar fibromatosis, Palmar tendinitis, Retinacular ganglion of the A-1 pulley, Tendon nodule of stenosing tenosynovitis, Tophi, Traumatic scars, Callus, Ganglion cyst, Prolapsed flexor tendon, Ulnar nerve palsy, Camptodactyly, Changes secondary to rheumatoid arthritis, Hyperkeratosis, Non-Dupuytren disease, Palmar ganglion.

• #2 Diagnosis of Dupuytren’s | The British Dupuytren’s Society

  https://dupuytrens-society.org.uk/information/dupuytrens-disease/dupuytrens-diagnosis/

  How Dupuytren’s is diagnosed […] In most cases an experienced doctor (GP or hand surgeon) does not need any extra tests to diagnose Dupuytren’s disease. The main things the doctor will do are: […] The doctor may measure the degree of contracture with a goniometer: […] If extra tests are required, the doctor can arrange one or more of the following procedures: […] Ultrasound examination […] Using some contact gel (which washes off easily) and an ultrasound scanning machine an experienced sonographer can scan your hands and fingers and look for any sign of nodules or cords. These will present as thickening in the fascia, usually hypoechoic, which means they produce less white specks on the picture than the tissues around them. […] MRI-(magnetic resonance imaging) […] An MRI depends on the machine magnitizing the tissue, then it measures how soon the protons in the tissue ‘relax’ (lose the magnetism). It measures in 2 directions: T1 weighed is longitudinal, T2 weighed transverse. For hand and foot examinations contrast is not normally needed but can be used to give clearer pictures. The patient is seated on a chair and the hand and wrist are placed in a small MRI machine. Dupuytren’s tissue give a low intensity signal (not many white dots) on T1 and T2, but if the nodule or the fascia is cellular it is more intense (more white), and this can tell the surgeon how much tissue needs to be removed to reduce the chance of recurrence. In some cases the patient may be given a contrast drink or injection to make the changes more obvious in the test. There have been a few cases where the nodules and cords could be felt but failed to show up at all on an MRI.

• #2 Dupuytren’s Contracture – TeachMeSurgery

  https://teachmesurgery.com/orthopaedic/wrist-and-hand/dupuytrens-contracture/

  The diagnosis of a Dupuytrens contracture is a clinical one. Patients can have selected routine blood tests performed, such as a HbA1C test, to assess for potential associated risk factors. […] Surgical management is typically indicated in those with functional impairment, MCP joint contracture 30 degrees, any PIP contracture, or rapidly progressive disease.

• #2 Dupuytren’s contracture – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/983?q=Dupuytren%27s%20contracture&c=suggested

  Dupuytren’s contracture is an inherited disease of progressive fibrous tissue contracture of the palmar fascia. […] Patients present with a small lump or multiple lumps with pits in the palm of the hand, progressing to contractures of the fingers. […] Surgical referral should be made when metacarpophalangeal joint contractures reach 30 degrees, or if any degree of proximal interphalangeal joint contracture is present. […] Key diagnostic factors include presence of risk factors, male 40 years of age, difficulties with manual activities, palmar nodule, palmar skin changes, pretendinous cords, MCP joint contracture, proximal interphalangeal (PIP) joint contracture, and positive Hueston table-top test. […] Investigations to consider include ultrasound of hand.

• #2 Dupuytren’s Contracture: Treating the Closed Hand Syndrome

  https://www.hss.edu/condition-list_dupuytrens-contracture.asp

  Dupuytren’s contracture can interfere with a persons daily activities and one of the most common conditions that hand surgeons treat. […] Dupuytren’s should not be confused with trigger finger, a separate condition which also causes fingers to flex uncontrollably. […] The physician usually makes the diagnosis based on the appearance of a patients hands and fingers and the range of movement. An MRI or other imaging studies are generally not needed. […] When seeking a diagnosis or treatment, its better to see a doctor sooner rather than later. Once a contracture is severe, Dupuytrens disease is more difficult to correct. […] At HSS, we have strict criteria for recommending surgery for Dupuytrens contracture. We do not recommend it for patients with early disease that is not interfering with their lives. We do advise patients to have their hand checked periodically, and we recommend a simple table-top test that can be done at home to help recognize progression. This is performed by simply placing ones hand down flat on a surface if one or more fingers can no longer lie flat on the table, it is time to visit the hand specialist. […] Surgery is reserved for those with Dupuytrens who are experiencing symptoms that impede hand function. The goal is to restore motion in their fingers so they can regain normal use of their hand.

• #2 Dupuytren’s: Questions for and From Your Doctor

  https://www.webmd.com/a-to-z-guides/dupuytrens-disease-frequently-asked-questions

  The treatment you receive will depend on the location, stage, and severity of the disorder. In your initial consultation, your doctor will probably provide a brief overview of how Dupuytren’s is treated. A newer procedure uses enzyme injections to dissolve the tissue. This is usually used first as it is least invasive. In cases where contracture has progressed, surgery is the most common treatment. Another treatment method uses needles to break up affected tissue. […] As mentioned earlier, the recurrence rate of Dupuytren’s symptoms is high, so whatever treatment you have may need to be repeated. Recurrence rates are lower after surgery than after needle or enzyme procedures.

• #2 Dupuytren Contracture: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/329414-overview

  A variety of non-surgical and surgical options are available for management of Dupuytren disease. The choice largely depends on the severity of disease, degree of deformity, limitations in function, and provider preference. Collagenase injection followed by rupture of the pathologic cord through passive extension has become a first-line treatment. […] Surgical procedures are reserved for patients with contractures 30-40 or with significant disability.

• #2 Dupuytren’s Disease – Dupuytren’s Contracture – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/dupuytrens-disease/

  If the contracture interferes with hand function, your doctor may recommend surgical treatment. […] The goal of surgery is to reduce the contracture and improve motion in the affected fingers. […] There is no known cure for Dupuytren’s contracture; however, surgery is intended to „set back the clock” by reducing the restricting (limiting) effect of the cords by either disrupting or removing them. […] Your doctor will talk with you about which procedure is best in your case. […] Dupuytren’s contracture typically progresses (gets worse) very slowly, over a period of years. […] Most patients have improved movement in their fingers after surgery. However, because the condition is not „cured” with surgery, about 20% of patients will experience a meaningful degree of contracture recurrence (the contracture comes back).

• #2 Dupuytren’s Contracture: What is it? Symptoms, Causes & Treatment | The Hand Society

  https://www.assh.org/handcare/condition/dupuytrens-contracture

  Before treatment, the hand surgeon will discuss realistic goals and possible risks. […] It is important to make sure the patient will understand this problem and both short- and long-term expectations. […] The main reason to undergo treatment is to increase your ability to straighten the finger.

• #3 Dupuytren’s Contracture | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/dupuytrens-contracture

  A physical examination of the palm by touch called palpation confirms the presence of the contracture or shortening of the tissue. […] A good guideline for determining when to consider surgery is the „table top test.” Try to place the palm of your hand completely flat on a hard surface. If you can’t, the contracture has progressed to a point where surgical intervention may be helpful.

• #3 Diagnosis of Dupuytren’s | The British Dupuytren’s Society

  https://dupuytrens-society.org.uk/information/dupuytrens-disease/dupuytrens-diagnosis/

  Xrays or CT scanning (CT is a series of xrays through the tissue, close together). As they show mainly bone structure it can be good to use these test to identify other problems the patient may have with their hands, such as arthritis which can affect the outcome of any treatment. […] Histopathology or lab tests on the removed tissue (biopsy) […] The diagnosis is not always clear or expected, and sometimes a laboratory report after surgical removal is needed to tell exactly what the tissue consisted of, and give a clear diagnosis.

• #3 Dupuytren’s contracture – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/983

  Dupuytren’s contracture is an inherited disease of progressive fibrous tissue contracture of the palmar fascia. […] Surgical referral should be made when metacarpophalangeal joint contractures reach 30 degrees, or if any degree of proximal interphalangeal joint contracture is present. […] Key diagnostic factors include presence of risk factors, male 40 years of age, difficulties with manual activities, palmar nodule, palmar skin changes, pretendinous cords, MCP joint contracture, proximal interphalangeal (PIP) joint contracture, and positive Hueston table-top test. […] Investigations to consider include ultrasound of hand.

• #3 Dupuytren’s Contracture: Causes and Treatment | Doctor

  https://patient.info/doctor/dupuytrens-contracture-pro

  Although surgical procedures such as fasciectomy or fasciotomy are often used for advanced disease, recent advances in the management of Dupuytren’s disease have shown benefit of less invasive treatments, such as radiotherapy, particularly for early disease. […] There is not yet evidence that one treatment is superior to others. […] The procedure can be performed in an outpatient setting, using local anaesthesia. […] A review found a complication rate of 19% after needle fasciotomy, 17% after fasciectomy, and 12% after dermofasciectomy. […] Surgery can improve hand functionality but will not eradicate the disease.

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