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Dupuytren’s contracture is the localised thickening and contraction of the palmar aponeurosis leading to flexion deformity of the adjacent fingers. Risk factors include: smoking, alcohol, hypothyroidism and HIV.
It presents with fixed flexion of the fingers, most commonly the 4th and 5th digits, associated with the palpable thickening of the palmar aponeurosis.
Early Dupuytren’s contracture is often managed conservatively with observation. Interventional options for functionally significant contractures include collagenase injections, needle aponeurotomy or surgery, with other approaches used less commonly in selected cases.
Image - The hand of a patient with Dupuytren's contracture
Creative commons source by Frank C. Müller, Baden-Baden [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Rheumatoid Arthritis of Finger Joints
Rheumatoid arthritis causes pain and swelling of the finger joints, often bilateral. It can cause two types of deformity:
- Swan neck deformity - hyperextension of the proximal interphalangeal joint with flexion of the distal interphalangeal joint. This is due to lax tissues on the palmar aspect of the proximal interphalangeal joint as a result of adjacent synovitis.
Image - A patient with swan neck deformity
Creative commons source by Phoenix119 [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
- Boutonnière deformity - flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint.
Image - A patient with Boutonnière deformity
Creative commons source by Prashanthns [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Osteoarthritis of Finger Joints
Osteoarthritis most commonly affects the 1st carpometacarpal joint and it is more common in women than in men. It presents with pain, swelling, squaring of the hand, stiffness and Heberden’s nodes (swellings of the distal interphalangeal joints) or Bouchard’s nodes (swellings of the proximal interphalangeal joints).
Image - An X-Ray of osteoarthritis affecting the finger joints, with Heberden's and Bouchard's nodes
Creative commons source by J. Lengerke 21:37, 27. Mai 2009 (CEST) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Psoriatic arthropathy is the asymmetrical oligoarthritis of psoriasis patients. It most commonly affects the distal interphalangeal joints and presents with fusiform (sausage-shaped) swelling of the digits with onycholysis (separation of the nails from the nail bed).
Mild cases can be treated with NSAIDs alone, but more severe cases may require disease-modifying anti-rheumatic drugs (DMARDs).
Image - An MRI scan of a patient with psoriatic arthropathy
Creative commons source by Fiona McQueen, Marissa Lassere and Mikkel Østergaard [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Rheumatoid nodules are an extra-articular manifestation of rheumatoid arthritis. They affect around 20% of people with rheumatoid arthritis and are usually found in smokers with a more aggressive form of rheumatoid arthritis. The nodules are usually non-tender and occur in regions exposed to minor trauma.
They do not always require treatment, but if they restrict movement or cause pain, management focuses on overall control of rheumatoid arthritis. The effect of individual DMARDs on nodules can vary.
Gouty tophi are nodular masses of monosodium urate crystals that are deposited in soft tissues. They are a late complication of hyperuricaemia. This condition is most commonly seen on the fingers but can be found on the ears or elbows. The nodular masses themselves are usually painless.
They do not always require treatment, but tophi are usually managed with urate-lowering therapy to reduce their size. Surgical removal is reserved for selected cases, for example if there is infection, ulceration, nerve compression or severe functional impairment.
Image - Gouty tophi nodules on a patient's fingers
Creative commons source by Michael (a.k.a. moik) McCullough [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Reviewed by: Dr. Thomas Burnell
Edited by: Dr. Maddie Swannack
In this article
The conditions of the hand included in this article are: Dupuytren’s contracture Rheumatoid arthritis of finger joints Osteoarthritis of finger joints…
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