Dupuytren's Exam

Look

 

Palms up

 

Scars / Dimples / pits 

 

Nodules - palm, proximal to distal palmar crease

 

Cords - extend into fingers & cause contracture

 

Thumb

 

Fingers - contracture of MCPJ, PIPJ

 

Palms down

 

Garrod knuckle pads

 

Hueston Table Top Test

- contracture MCPJ

- contracure PIPJ

 

Feel

 

Nodules / Cords / Webspaces (Natatory cords)

 

Sensation

 

Move

 

Deformities 

- stiff or flexible

 

PIPJ

- true v apparent FFD

- spiral cord crossing MCPJ and PIPJ may contract both

- flex MCPJ

- assess PIPJ

 

Concepts

 

MCPJ Contracture

- Always correctable by removal of pretendinous bands

- Collateral ligaments are tightest in flexion

- Flexion deformity does not lead to collateral shortening 

- Resection central cord restores extension

 

PIPJ 

 

Contracture due to 4 cords

1.Central 

2.Spiral

- pushes NV bundle volar and midline 

- from spiral band and Grayson's ligaments

3.Lateral 

- lateral digital sheath

4.Retrovascular

 

Not always correctable unless release volar plate & accessory collateral ligaments 

- Collateral ligaments tightest in extension 

- Flexion deformity leads to collateral shortening