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Case 205

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62 year-old male patient seeks medical care complaining that his hand is “becoming bent”. He states that the process has started over 10 years ago, with the appearance of some lumps in his palm, and that he does not feel pain, only a slight itch. He has hypertension, taking 50 mg of losartan a day, drinks alcohol frequently, is a chronic smoker and has worked as a drover for 50 years. Upon physical examination, his fourth and fifth fingers were rigid and incapable of complete extension.

Based on the history and the image, which of the following are the observed alteration and possible risk factor, respectively?

a) Quervain's tenosynovitis – Repetitive strain injury

25%

b) Trigger Finger - Idopathic

25%

c) Dupuytren’s contracture - Alcoholism

25%

d) Palm calluses – Labor

25%
   

Image analysis

Image 1: Left hand photo, showcases contraction of the palmar fascia, with the formation of cords directed to the fifth finger, which stays in fixed flexion (red arrow).

Highlights

- The Dupuytren’s Contracture is a relatively common, benign and insidious disease.

- It is considered a idiopathic disease, but is associated with consumption of alcohol, smoking and diabetes.

- It affects mostly males over 40 years of age, with its incidence increasing with age.

- The diagnosis is clinical and based on history of painless rigidness of the fingers and characteristic findings in the physical examination, such as firm lumps and cords stuck to the skin and bending of the fourth and fifth fingers, mostly.

- The treatment seeks the improvement of the flexibility of the tendons. Surgery is indicated when the patient has a metacarpophalangeal contracture of 30 degrees or more, and no longer is able to pace his opened hand over a flat surface.

References

- Cohen M. Tratado de Ortopedia. São Paulo-SP.2006. 863 p.

- Ruaro AF. Ortopedia e Traumatologia: temas fundamentais e a reabilitação. Umuarama2004.

- Blazar PE, Aggarwal R. Dupuytren's contracture. Uptodate [Internet]. 2015. Acessado no dia 12 de setembro de 2015.

- Pignataro MB. Doença de Dupuytren. Porto Alegre2013

Author

Hercules Hermes Riani Martins Silva, 6th year medical student at UFMG.

E-mail: herculesriani[arroba]gmail.com

Supervisor

Ubiratan Brum de Castro, Professor of Orthopedics and Traumatology –UFMG

E-mail: ubrum(arroba)terra.com.br

Reviewers 

Luísa Bernardino, André Guimarães, Fabio M. Satake, Júlia A. Petrocchi and Profa. Viviane Parisotto.

Translated by

Rafael Fusaro Aguiar Oliveira, 4th year medical student at UFMG.

E-mail: rafusaro[at]hotmail.com

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