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Diseases » Dupuytren's contracture » Diagnosis

Diagnosis of Dupuytren's contracture

Dupuytren's contracture Diagnosis: Book Excerpts

Diagnostic Tests for Dupuytren's contracture: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Dupuytren's contracture.

Wrist & Hand Pain/Swelling: Differential Diagnosis
(In a Page: Signs and Symptoms)

Carpal tunnel syndrome
–Most common cause of significant wrist discomfort and morbidity
–Associated with repetitive use activities (e.g., typing)
–Pain and numbness symptoms result from entrapment of the median nerve under the transverse ligament
Overuse injury
Osteoarthritis
Tenosynovitis (DeQuervain's) of the radial wrist
–Results from inflammation of the tendon sheaths of the extensor pollicis brevis and abductor pollis longus
- Ganglion cysts
  –Common growths of tendons and ligaments in the wrist area occurring on both the dorsal and ventral surface
  –They are compressible, round, often tender, and mobile
- Trauma
  –The most common mechanism of injury is a fall on the outstretched hand
  –The most commonly fractured carpal bone is the scaphoid
  –Other mechanisms include direct blows, crush injuries, fall on an angulated wrist, and severe twisting motions
- Fibromyalgia
- Compartment syndrome
- Chest or shoulder masses, resulting in compression of lymphatic or venous systems
- Venous thrombosis of the subclavian or distal veins
- Flaccid paralysis following a CVA
- Angioedema secondary to hymenoptera sting
- Rheumatologic disease
- Peripheral neuropathy
- Insect or animal bite/sting
- Infection (e.g., staphylococcus aureus, streptococci)
Workup and Diagnosis
- History and physical examination of the hand, wrist, elbow, and shoulder
  –Tinel's sign is positive if pain is elicited by tapping the anterior wrist
  –Phalen's sign is positive if wrist flexion for >30 seconds elicits pain or numbness
- Lab investigation is usually unnecessary, but may include rheumatoid factor, ANA, ESR, CBC, uric acid, TSH, β-hCG (pregnancy test)
Standard X-rays include PA, lateral, and oblique views
EMG and nerve conduction studies are indicated if carpal tunnel syndrome or other neuropathy is suspected
Arthrocentesis with crystal analysis may be indicated if warmth and redness are noted in the wrist and MCP joints
Bone scan may be necessary to evaluate for avascular necrosis, occult fracture, or bone infection
Rarely, CT or MRI is indicated
Shoulder/chest CT may be indicated to evaluate for masses resulting in nerve entrapment or vascular compromise

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Source: In a Page: Signs and Symptoms, 2004

EXTREMITY, HAND, AND FOOT DEFORMITIES: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

It is usually a simple matter to decide whether the deformity is due to neurologic disease or to joint or bone disease. An x-ray film of the hands or feet may be useful in acromegaly and many congenital disorders. Referral to an orthopedic or neurologic specialist is usually indicated if bone or neurologic involvement is probable. An arthritis workup can be done (see page 343) if joint disease is the cause of the deformity.

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Source: Differential Diagnosis in Primary Care, 2007

Wrist/Hand Pain: Differential Overview
(Field Guide to Bedside Diagnosis)

Phenomena

❑ Wrist sprain

❑ Paronychia

❑ Ganglion cyst

❑ Carpal tunnel syndrome

❑ Ulnar neuropathy

❑ Trigger finger

❑ Mallet finger

❑ Digital ganglion

❑ Dupuytren contracture

❑ De Quervain tenosynovitis

❑ Colle fracture

❑ Navicular fracture

❑ Metacarpal fracture

❑ Felon

❑ Bennet fracture

❑ Smith fracture

❑ Flexor tendon rupture

❑ Reflex sympathetic dystrophy

❑ Lunate dislocation

Hands in Arthritis

❑ Osteoarthritis

❑ Rheumatoid arthritis

❑ Gout

❑ Systemic lupus erythematosus

❑ Psoriatic arthritis

❑ Scleroderma

❑ Gonococcal arthritis

Diagnostic Approach

Pain, swelling, and fusiform enlargement of multiple hand joints is characteristic of inflammatory arthritis. Involvement of the DIP joints is seen with psoriatic arthritis, and of the PIP and MCP joints with rheumatoid arthritis. Osteoarthritis involves both the PIP and DIP joints, but the swelling is more bony than soft tissue.

With infection, swelling is most prominent in the dorsum of the hand regardless of the original location.

Grip strength can be compared grossly by simultaneously gripping the examiner’s fingers using both hands, or quantitatively by gripping a tightly rolled, slightly inflated blood pressure cuff.

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Source: Field Guide to Bedside Diagnosis, 2007