Name of the Condition

• Palmar fascial fibromatosis [Dupuytren]
• Commonly known as Dupuytren's contracture.

Summary

• Dupuytren's contracture is a hand condition where thickened tissue (fascia) in the palm forms knots and causes one or more fingers to bend inward towards the palm. It gradually progresses over time and can restrict finger movement.

Causes

• The exact cause is not known, but it may be associated with genetic predisposition. It involves abnormal thickening of collagen in the connective tissue.

Risk Factors

• Age: Most commonly affects individuals over 40.
• Gender: More prevalent in men than in women.
• Family History: Increased risk if a family member has the condition.
• Ancestry: More common in people of Northern European descent.
• Alcohol and Tobacco Use: Associated risk due to potential effects on collagen.

Symptoms

• Nodules or lumps in the palm.
• Thickened cords of tissue under the skin in the palm.
• Restricted finger movement, often affecting the ring and little finger.
• Gradual onset of finger bending or curling.

Diagnosis

• Physical exam: Doctor examines the hands for nodules or cords and assesses finger movement.
• Table test: Simple test where the patient places their hand flat on a table to observe the extent of bending.

Treatment Options

• Watchful Waiting: In mild cases, monitoring the condition without immediate treatment.
• Needling: Minimally invasive technique to break the cord of tissue.
• Enzyme Injections: Injectable enzyme treatments like collagenase help soften and break down the tissue.
• Surgery: Fasciectomy or fasciotomy to remove or cut the affected tissue and improve movement.

Prognosis and Follow-Up

• Prognosis varies; some people may experience slow progression, while others require treatment to maintain hand function.
• Regular hand exercises and follow-ups with a healthcare provider may help manage symptoms and monitor progression.

Complications

• If untreated, Dupuytren's contracture can lead to permanent finger stiffness and loss of hand function, making daily tasks difficult.

Lifestyle & Prevention

• Maintaining optimal hand health with regular exercises and stretches.
• Limiting alcohol and tobacco use might reduce risk factors.

When to Seek Professional Help

• Seek medical advice if you notice lumps in your palm, difficulty extending your fingers, or if the condition interferes with hand function.

Additional Resources

• American Society for Surgery of the Hand (ASSH)
• Dupuytren Research Group
• Patient support groups and rehabilitation services.

Tips for Medical Coders

• Ensure accurate diagnosis coding by confirming the presence of palmar fascial fibromatosis without generalizing to other fibromatoses.
• Avoid common coding errors by differentiating between primary condition and secondary restrictions in mobility.