What are the key clinical features to diagnose Dupuytren's contracture in a primary care setting?

Key clinical features used to diagnose Dupuytren's contracture in primary care include:

• The presence of palpable nodules or cords in the palmar fascia, typically starting in the palm and potentially extending to the fingers.
• Progressive flexion contracture of the fingers, especially at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, leading to loss of finger extension.
• Signs of functional impairment or significant loss of hand function due to contracture.
• Occasionally, painful nodules may be present even before contracture develops.
• Onset usually from age 18 years onwards, with a progressive nature.

Diagnosis is primarily clinical, based on history and physical examination identifying these nodules, cords, and contractures. Referral to a hand surgeon or specialist is recommended when contracture or significant functional loss is evident, or if painful nodules are present and clinical judgement suggests referral is appropriate.

Early recognition of nodules and contractures is important as untreated contractures tend to progress and may not fully straighten with treatment later.

Reassurance should be provided that the condition is not cancerous, and patients should be advised to return for review if contracture develops.

There is no role for routine imaging or laboratory tests in primary care diagnosis.

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