(BMJ)—A 65-yo retired farmer presented w/ the inability to fully straighten his R ring and little fingers, which had worsened over 2y. He denied hx of trauma. Exam: palpable cords to middle, ring, and little fingers; nodules on volar aspect of all proximal phalanges; metacarpophalangeal and proximal interphalangeal joint contractures. What is the dx?
Rheumatoid arthritis
Soft tissue sarcoma
Camptodactyly
Dupuytren dz
Inclusion cysts
You are correct. Dupuytren dz involves fibroproliferation of the palmar fascia, which can lead to permanent flexion contractures of affected digits. It mainly affects older men of northern European descent. Inclusion cysts move freely beneath overlying skin. Contractures from camptodactyly develop in childhood or adolescence. Sarcoma may present as innocuous nodules in the palm or w/ ulceration or proximal spread into flexor tendons. This pt was treated w/ dermofasciectomy and skin graft and achieved full range of motion after 4wk of PT. There was no evidence of recurrence after 6mo.

BMJ 2014;349:g6137
By vgreene, 24 January, 2017

VVC