Diagnosis

How Dupuytren’s is diagnosed

Physical examination

In most cases an experienced doctor (GP or hand surgeon) does not need any extra tests to diagnose Dupuytren’s disease. The main things the doctor will do are:

  • Ask a detailed history, when did you first notice this, did any injury happen that set it off, does anybody in your family have something similar

  • The doctor will look at your hands and examine them by palpation, feeling in your palm and fingers for any lumps or cords present

  • The doctor will ask about or check for problems elsewhere, mainy feet and shoulders and for men the penis.

  • A table top test may be done to see if contracture is present, which mean you need to put your hand palm down on a table and see if the hand can lay flat

Negative test

  negative tabletop

Positive test

positive tabletop

The doctor may measure the degree of contracture with a goniometer:

goniometry

If extra tests are required, the doctor can arrange one or more of the following procedures:

Ultrasound examination

Using some contact gel (which washes off easily) and an ultrasound scanning machine an experienced sonographer can scan your hands and fingers and look for any sign of nodules or cords. These will present as thickening in the fascia, usually hypoechoic, which means they produce less white specks on the picture than the tissues around them.

 

MRI-(magnetic resonance imaging)

An MRI depends on the machine magnitizing the tissue, then it measures how soon the protons in the tissue ‘relax’ (lose the magnetism). It measures in 2 directions: T1 weighed is longitudinal, T2 weighed transverse. For hand and foot examinations contrast is not normally needed but can be used to give clearer pictures.

The patient is seated on a chair and the hand and wrist are placed in a small MRI machine.

Hand and wrist MRI scan: WristView MRI_Patient_Scan                                                        picture courtesy of  Aspect Imaging

 

Dupuytren’s tissue give a low intensity signal (not many white dots) on T1 and T2, but if the nodules or the fascia is cellular it is more intense (more white), and this can tell the surgeon if more tissue needs to be removed to reduce the chance of recurrence. (Yacoe et al, 1992).

In some cases the patient may be given a contrast drink or injection to make the changes more obvious in the test. There have been a few cases where the nodules and cords could be felt but failed to show up at all on an MRI.

 

Xrays or CT scanning
(CT is a series of xrays through the tissue, close together). As they show mainly bone structure it can be good to use these test to identify other problems the patient may have with their hands, such as arthritis which can affect the outcome of any treatment.

Histopathology or lab tests on the removed tissue

The diagnosis is not always clear or expected, and sometimes a laboratory report after surgical removal is needed to tell exactly what the tissue consisted of, and give a clear diagnosis.

microscope