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Dupuytren’s contracture is a benign fibroproliferative disorder affecting the palmar fascia, leading to progressive thickening, nodularity, and contracture of the fingers—most commonly the 4th and 5th digits.
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What is Dupuytren's Contracture/
| Feature | Description |
|---|---|
| Age | >40 years (peak 50–70) |
| Sex | Male > Female (9:1) |
| Ethnicity | Northern European descent (“Viking’s disease”) |
| Risk factors | • Genetic predisposition |
| • Alcoholism | |
| • Diabetes | |
| • Smoking | |
| • Epilepsy (esp. on phenytoin) | |
| • HIV infection | |
| • Manual labor/vibration exposure |
| Feature | Description |
|---|---|
| Site of origin | Pretendinous bands of the palmar aponeurosis, especially ulnar side |
| Cell type involved | Myofibroblasts with excessive collagen (type III) deposition |
| Progression | Begins with nodules, followed by cord formation and contracture |
| Stages | Proliferative → Involutional → Residual (fibrotic contracture) |
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Not tendon pathology – affects fascia, sparing the flexor tendons.
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| Feature | Description |
|---|---|
| Location | Palmar fascia → most commonly affects ring (4th) and little (5th) fingers |
| Palpable nodules | Firm, fixed nodules on distal palm |
| Cords | Fibrous cords extending into fingers |
| Finger contracture | Flexion deformity at MCP and PIP joints |
| Pain | Usually absent or mild |
| Bilateral | In ~50% of cases |
| Modality | Imaging features |
|---|---|
| US | • B-mode: Hypoechoic nodules or cords superficial to flexor tendons |
| • Dynamic imaging: Confirms fascial origin and mobility relative to tendon sheath | |
| • Doppler: Minimal to no vascularity | |
| MR | MRI is not routinely required, but helpful if extension into digit pulleys, deep tissues, or recurrent disease is suspected. |
| • T1: Iso- to hypointense nodules and cords in palmar fascia | |
| • T2: Variable signal intensity (active lesions brighter) | |
| • Post-contrast: May enhance mildly in early active phase | |
| • Location: Lesions along pretendinous bands; often displacing flexor tendons posteriorly |
| Condition | Distinguishing Feature |
|---|---|
| Trigger finger | Nodule in tendon, painful catching, located near A1 pulley |
| Flexor tenosynovitis | Diffuse tendon sheath thickening and fluid |
| Palmar fibroma | Isolated well-circumscribed mass |
| Sarcoma | Rapid growth, deeper location, heterogeneous, aggressive MRI features |