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Dupytrens Contracture

 

Investigations are not usually necessary to diagnose Dupuytren’s disease. However, if the history raises suspicion of diabetes mellitus or alcohol-related liver disease, arrange blood tests as appropriate.

To justify the risks of surgery a flexion deformity must be present.

Surgery for Dupuytrens contracture is commissioned where patients meet the criteria below:

 

Refer for surgery if

  • MCPJ deformity and causing a significant functional impairment* 

OR

  • PIPJ deformity/contracture greater than 20o

OR

  • multiple joints with significant functional impairment *

OR

  • Recurrence after surgery with functional impairment* (consider referral on first presentation)

AND

  • the patient is willing to have an operation

 

*Note:  Significant Functional Impairment is defined as

  • Symptoms that result in an inability to sustain employment despite reasonable occupational adjustment, or act as a barrier to employment or undertake education
  • Symptoms preventing the patient carrying out self-care, maintaining independent living or carrying out carer activities

 

Treatment is NOT commissioned for

  • purely cosmetic purposes
  • in cases where there is no contracture    

OR

  • the contracture is not progressing and does not impair function

 

For people with Dupuytren’s disease who do not have contracture or any significant loss of function

  • No treatment is necessary at this stage.
  • Provide an explanation of the condition and reassure the person that any painful nodules should improve with time.
  • Advise the person to return for review if a contracture develops, as referral is then recommended.
  • Corticosteroid injections, splinting and radiotherapy are not recommended.

 

A validated decision aid tool should be used during the consenting process to ensure that the patients’ desired outcomes have been considered.

NHS_Dupuytren's_contracture_decision_tool

 

References

  • Dupytren’s Contracture, Clinical Knowledge Summaries, National Institute of Clinical Excellence 2022
  • Dupuytren’s Disease.  British Society For Surgery Of The Hand http://www.bssh.ac.uk/patients/conditions/25/dupuytrens_disease
  • Dupuytren’s Contracture Release In Adults (National Evidence Based Intervention). Cornwall and IoS Commissioning Policy and Evidence Based Interventions, April 2025.

 

Page Review Information

Partial Review                    13 May 2025

Next review due                 13 May 2026

Sifter name                         Dr Laura Lomas

       Dr Rebecca Hopkins