GPAtlas🧭 When to suspect
Dupuytren's disease is a benign, slowly progressive fibroproliferative disorder of the palmar and digital fascia. Thickened tissue forms nodules and then cords that can draw one or more fingers into fixed flexion – most often the ring and little fingers. It is common, affecting around 4% of the UK population and a much higher proportion of older men, and is strongly associated with Northern European ancestry. It is up to six times more common in men than women.
Most disease is painless and never needs intervention – only about one in three affected people progress to a cord and contracture. The clinical task in primary care is threefold: recognise it clinically, decide who needs referral (driven by contracture and hand function, not by the mere presence of a nodule), and do not mislabel an atypical hand lump as Dupuytren's.
Suspect Dupuytren's when there is thickening, pitting or puckering of the palmar skin, a firm palmar nodule, or a cord with early bending of a finger. Raise your index of suspicion with a family history, increasing age, smoking, excess alcohol, or diabetes.
| Clinical picture | Primary-care action |
|---|---|
| Palmar nodule(s) only, no contracture | Reassure, observe and safety-net; tender nodules usually settle with time. |
| Cord with mild contracture, hand still lies flat, function preserved | Observe and address risk factors; refer if progressing or affecting function. |
| Cannot lay the palm flat (positive Hueston tabletop test), or MCP ≥ 30° / PIP ≥ 20° | Refer to hand surgery. |
| Significant functional impairment (any angle) | Refer to hand surgery. |
Source: NICE · BSSH
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.