- Consider Diagnosis (discuss within peer review)
- Skin thickening, pitting or nodules in the palm.
- Fibrous cords in the palm and/or digits.
- Flexion deformity at the MCP and/or PIP joints.
- Ring finger most commonly affected, followed by little and middle fingers.
- Risk factors include; diabetes, epilepsy, family history, smoking, alcohol consumption and previous trauma.
- Garrod’s knuckle pads may be present.
- Exclude red flags.
- No functional problems.
- Mild metacarpo-phalangeal joint contracture (< 30 degrees).
- Observe and follow advice listed.
- Notable functional problems.
- Moderate metacarpo-phalangeal joint contracture (30-60 degrees).
- Moderate inter-phalangeal joint contracture (> 30 degrees).
- First Web Contracture.
- Consider referral to surgeon if patient considers surgical treatment.
- Severe contracture of both metacarpo-phalangeal joint (>60 degrees and proximal inter-phalangeal joint (.30 degrees).
- Refer to surgeon if patient fits criteria for surgery.
If diagnosis uncertain refer to Interface Team
If contracture <30 degrees at affected joint/s:
- Use hand as normally as possible.
- Reassure that tender nodules likely to become pain-free with time.
- No evidence that splinting reduces contractures before surgery.
- Smoking cessation if applicable.
- Teach patients table top test.
- Referral to physiotherapy or Occupational Therapy is not indicated pre operatively.
Referral for Orthopaedic opinion via Interface Team.