Dupuytren's contracture refers to flexion deformities of the fingers resulting from progressive contracture of the palmar fascial bands.

This condition tends to occur in families, more frequently in men. It occurs also in patients with diabetes mellitus, alchoholism, or epilepsy. The actual cause is unknown.

The right hand is affected most often. The condition starts first in the palm of the hand with a tender nodule, which is followed by a longitudinal cord-like band that eventually arches the hand. This leads to contracture of the metacarpophalangeal joint (MCP) and finger joints. The flexed fingers interfere with hand function.

When flexion of the MCP joint is greater than 30 degrees, or any flexion contracture of the proximal interphalangeal (PIP) joint is present, then surgery is indicated.

Early treatment involves local injections of a corticosteroid to delay fibrotic changes. When surgery is done, the contracted palmar fascia and fibrous bands are released and excised. This allows the hand to extend. A splint is worn on the palmar side holding the MCP and PIP joints in extension, day and night, for six weeks. Following this, the splint is worn only at night for an additional three months.

Physical therapy on the hand is required after surgery to regain motion. Approximately 3 months may be needed before work is resumed.

• The rating schedule does not specifically list Dupuytren’s contracture as a disease entity; therefore, assign an evaluation on the basis of limitation of finger movement.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Refer to Special Considerations under Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand.

• For the index, long, ring, and little fingers (digits II, III, IV, and V), zero degrees of flexion represents the fingers fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the wrist dorsiflexed 20 to 30 degrees, the metacarpophalangeal and proximal interphalangeal joints flexed to 30 degrees, and the thumb (digit I) abducted and rotated so that the thumb pad faces the finger pads. Only joints in these positions are considered to be in favorable position. For digits II through V, the metacarpophalangeal joint has a range of zero to 90 degrees of flexion, the proximal interphalangeal joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal joint has a range of zero to 70 or 80 degrees of flexion.

• When two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level.

     Evaluation of ankylosis of the index, long, ring, and little fingers:

• (i) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, evaluate as amputation without metacarpal resection, at proximal interphalangeal joint or proximal thereto

• (ii) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position

• (iii) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of more than two inches (5.1 cm.) between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as unfavorable ankylosis

• (iv) If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as favorable ankylosis

     Evaluation of ankylosis of the thumb:

• (i) If both the carpometacarpal and interphalangeal joints are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, evaluate as amputation at metacarpophalangeal joint or through proximal phalanx

• (ii) If both the carpometacarpal and interphalangeal joints are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position

• (iii) If only the carpometacarpal or interphalangeal joint is ankylosed, and there is a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, evaluate as unfavorable ankylosis

• (iv) If only the carpometacarpal or interphalangeal joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, evaluate as favorable ankylosis

• If there is limitation of motion of two or more digits, evaluate each digit separately and combine the evaluations.