Dupuytren’s
contracture
The condition is inherited as an autosomal dominant trait and is more
common in males, with age, smoking, pulmonary tuberculosis, epilepsy, acquired
immunodeficiency syndrome (AIDS) and alcoholic cirrhosis. It is usually found in
those of Anglo-Saxon descent. Myofibroblasts in the palmar fascia proliferate
and contract. Initially, there is a nodular swelling in the palm. The overlying
skin then puckers. Cords running into the fingers contract causing a flexion
deformity of the metacarpophalangeal and proximal interphalangeal joints. The
skin over the back of the proximal interphalangeal joints may thicken (Garrod’s
knuckle pads — Fig. 30.17) and a few patients may have thickening in the penis
(Peyronie’s disease) or on the sole of the foot (Ledderhose’s disease).
Surgery
is advised if the deformity is a nuisance or if the deformity is rapidly
progressing, especially at the proximal interphalangeal joint where it soon
becomes irreversible.