Dupuytren’s Contracture

content of this page

1- Introduction

2- Anatomical Overview

3- Treatment

Introduction

Dupuytren’s contracture is a localized thickening and contracture of the palmar aponeurosis, which limits hand function and may eventually disable the hand. It commonly starts near the root of the ring finger and draws that finger into the palm, flexing it at the metacarpophalangeal joint. Later, the condition involves the little finger in the same manner. In long-standing cases, the pull on the fibrous sheaths of these fingers results in flexion of the proximal interphalangeal joints. The distal interphalangeal joints are not involved and are actually extended by the pressure of the fingers against the palm.

Anatomical Overview

The palmar aponeurosis is a crucial structure within the palm of the hand, playing a key role in hand function and mechanics. Here’s an overview of its anatomy, function, and clinical significance:

Anatomy of the Palmar Aponeurosis

Location: The palmar aponeurosis is a thick, triangular fibrous sheet located superficially in the center of the palm, extending from the distal end of the flexor retinaculum to the bases of the fingers.
Structure:
- Proximal Attachment: It is continuous with the palmaris longus tendon (when present) and the flexor retinaculum.
- Distal Attachment: It divides into four slips that extend into the fingers. Each slip further divides into two bands that merge with the fibrous digital sheaths and the deep transverse metacarpal ligaments.
Composition: The aponeurosis is made of dense connective tissue, providing strength and protection to the underlying structures.

Function of the Palmar Aponeurosis

Protection: It protects the underlying muscles, nerves, and blood vessels in the palm.
Support: It provides structural support to the palm, maintaining its shape and allowing efficient force transmission.
Attachment: It serves as an attachment site for the palmaris longus tendon (if present) and helps anchor the skin, enhancing grip and preventing slippage during object manipulation.

Treatment

Surgical division of the fibrous bands followed by physiotherapy to the hand is the usual form of treatment. The alternative treatment of injection of the enzyme collagenase into the contracted bands of fibrous tissue has been shown to significantly reduce the contractures and improve mobility.