History
Patients present with a lump in the palm and curled fingers, most commonly ring and little. Often bilateral, and affects the thumb side of the hand more commonly in Diabetics.
A positive family history should be looked for, and is the most common association. Associations with alcohol, epilepsy etc are worth looking for.
If the patient is young, then think about Dupuytrens Diathesis, which is severe Dupuytrens affecting not only the hands, but also the feet (Lederhosen’s disease) and the penis (Peroni’s disease).

Examination
Often nodules and cords can be felt passing from the palm to the affected finger. The MCP (knuckle) and PIP joints are the most commonly affected. Look for Garrods pads on the back (dorsum) of the PIP joint.
Finger flexion and neurological state should be normal.
Ask the patient to do the table top test. If they can flatten the fingers and palm to a flat surface, then surgery is probably not warranted.

Differential diagnosis

• Post traumatic joint contractures
• campylodactyly – congenital cause for a bent finger

Investigations
There are no specific investigations required to help with the diagnosis.

Treatment

• If minimal contracture and no functional loss, then conservative treatment is worth pursuing.
• If symptomatic then the options include needle fasciotomy (good for MCP contractures only), Collagenase injections (a new enzyme treatment, again best for MCP contractures) or surgical removal and release (fasciectomy or dermofasciectomy).
• Studies have shown no beneficial help from treatments including steroid injections, radiotherapy, ultrasound, physiotherapy, splints etc

When to refer
I have a rule of thumb that if the MCP Jt is contracted by more than 40 degrees and the PIP Jt by more than 20 degrees, then treatment is worth considering.
More severe contractures than this, especially in the PIP Jt will have a less successful surgical outcome.
Any young patient with disease should be referred early even if contracture is relatively mild.