A 2011 narrative review synthesizing the pathophysiology, anatomy, and treatment options for Dupuytren disease. It covers the molecular basis of myofibroblast-driven cord formation, the anatomic relationships that govern operative risk, and the evidence for surgical versus less-invasive interventions. Intended as a comprehensive reference for trainees managing palmar nodules and digital contractures.
Every cord in Dupuytren disease is not equally dangerous. The spiral cord's unique anatomy — winding deep to the neurovascular bundle at the MCP level before re-emerging superficially. Straightens as it contracts, pulling the bundle to the midline. Knowing this before you cut is the difference between a clean dissection and an iatrogenic nerve injury.
When you operate matters too. The thresholds are MCP ≥30° or any PIP contracture above 15°. The PIP joint is unforgiving: it is less likely to achieve full correction intraoperatively and more likely to lose whatever correction is gained by 6 months. Operating earlier on less deformed PIP joints improves the chance of durable correction.
For patients who cannot tolerate surgery, needle fasciotomy is a reasonable bridge. But counsel them that 85% will recur within a median of 3.7 years versus 24% after limited fasciectomy. Collagenase is a viable office-based option for MCP-predominant disease, where response rates are nearly double those seen at the PIP joint.
Dupuytren diathesis scoring (six factors: male, onset <50, bilateral, family history, Garrod pads, Northern European descent) should be calculated in every patient. A score of all six predicts 71% recurrence and should inform the consent conversation and the choice between dermofasciectomy and standard fasciectomy.
A 2011 narrative review synthesizing the pathophysiology, anatomy, and treatment options for Dupuytren disease. It covers the molecular basis of myofibroblast-driven cord formation, the anatomic relationships that govern operative risk, and the evidence for surgical versus less-invasive interventions. Intended as a comprehensive reference for trainees managing palmar nodules and digital contractures.
Every cord in Dupuytren disease is not equally dangerous. The spiral cord's unique anatomy — winding deep to the neurovascular bundle at the MCP level before re-emerging superficially. Straightens as it contracts, pulling the bundle to the midline. Knowing this before you cut is the difference between a clean dissection and an iatrogenic nerve injury.
When you operate matters too. The thresholds are MCP ≥30° or any PIP contracture above 15°. The PIP joint is unforgiving: it is less likely to achieve full correction intraoperatively and more likely to lose whatever correction is gained by 6 months. Operating earlier on less deformed PIP joints improves the chance of durable correction.
For patients who cannot tolerate surgery, needle fasciotomy is a reasonable bridge. But counsel them that 85% will recur within a median of 3.7 years versus 24% after limited fasciectomy. Collagenase is a viable office-based option for MCP-predominant disease, where response rates are nearly double those seen at the PIP joint.
Dupuytren diathesis scoring (six factors: male, onset <50, bilateral, family history, Garrod pads, Northern European descent) should be calculated in every patient. A score of all six predicts 71% recurrence and should inform the consent conversation and the choice between dermofasciectomy and standard fasciectomy.