ICD-10: M72.0

Palmar fascial fibromatosis, commonly known as Dupuytren's contracture, is a condition characterized by the thickening and shortening of the palmar fascia, which can lead to the bending of one or more fingers towards the palm. This condition is classified under the ICD-10 code M72.0.

Clinical Description

Definition

Dupuytren's contracture is a benign condition that primarily affects the palmar fascia, a connective tissue layer in the palm of the hand. The disease leads to the formation of nodules and cords in the fascia, which can progressively contract, causing the fingers to curl inward. This condition is often painless but can significantly impair hand function and grip strength over time.

Epidemiology

Dupuytren's contracture is more prevalent in certain populations, particularly among individuals of Northern European descent. It typically manifests in adults, with a higher incidence in men than women. The condition often develops gradually, with symptoms appearing in middle age or later, and it can be associated with various risk factors, including genetics, diabetes, and alcohol consumption[1][2].

Symptoms

The primary symptoms of Dupuytren's contracture include:
- Nodules: Small, firm lumps in the palm that may be tender or painless.
- Cords: Thickened bands of tissue that can form beneath the skin, leading to finger flexion.
- Contracture: The inability to fully extend the affected fingers, which can progress to significant functional impairment.

Diagnosis

Diagnosis is primarily clinical, based on the physical examination of the hand. Healthcare providers may assess the degree of contracture using the "table top test," where the patient is asked to place their hand flat on a surface. The inability to do so due to finger flexion indicates the presence of Dupuytren's contracture. Imaging studies are generally not required unless there is uncertainty in the diagnosis[3][4].

Treatment Options

Conservative Management

In the early stages, when contracture is minimal, treatment may not be necessary. However, options include:
- Splinting: Wearing a splint at night to help maintain finger extension.
- Physical Therapy: Exercises to improve hand function and flexibility.

Surgical Intervention

For more advanced cases where contracture interferes with daily activities, surgical options may be considered:
- Fasciectomy: Surgical removal of the thickened fascia.
- Needle Aponeurotomy: A minimally invasive procedure where a needle is used to break the cords.
- Collagenase Injection: An enzyme injection that helps dissolve the cords, allowing for improved finger extension.

Postoperative Care

Post-surgery, rehabilitation is crucial to regain hand function. This may involve physical therapy and splinting to prevent recurrence of contracture[5][6].

Conclusion

ICD-10 code M72.0 encapsulates the clinical aspects of palmar fascial fibromatosis, highlighting its nature as a progressive condition that can lead to significant functional impairment. Early diagnosis and appropriate management are essential to mitigate the impact of Dupuytren's contracture on patients' quality of life. For those experiencing symptoms, consulting a healthcare provider for evaluation and potential treatment options is advisable.

References

1. Dupuytren disease N068 | CLIK.
2. ICD-10-CM Diagnosis Code M72.0 - Palmar fascial fibromatosis.
3. Dupuytren's Contracture: Occupational Therapy.
4. Dupuytren Contracture | 5-Minute Clinical Consult.
5. Fibromatosis-palmar / plantar.

Palmar fascial fibromatosis, commonly known as Dupuytren's contracture, is a condition characterized by the thickening and shortening of the palmar fascia, leading to flexion deformities of the fingers. This condition is coded as ICD-10 code M72.0. Understanding its clinical presentation, signs, symptoms, and patient characteristics is essential for effective diagnosis and management.

Clinical Presentation

Dupuytren's contracture typically presents as a gradual thickening of the palmar fascia, which may lead to the formation of nodules and cords. The condition often progresses slowly, and patients may not notice significant symptoms initially. The clinical presentation can vary widely among individuals, but it generally follows a predictable pattern.

Signs

1. Palmar Nodules: The first noticeable sign is often the development of small, firm nodules in the palm, usually near the base of the ring or little finger. These nodules may be tender or painless.

2. Cord Formation: Over time, the nodules can evolve into fibrous cords that extend from the palm to the fingers, causing the fingers to bend towards the palm.

3. Flexion Deformity: As the condition progresses, patients may develop a noticeable flexion deformity of one or more fingers, particularly the ring and little fingers. This can interfere with hand function and daily activities.

4. Skin Changes: In advanced cases, the skin overlying the affected area may become dimpled or puckered due to the underlying fibrous tissue.

Symptoms

• Limited Finger Extension: Patients often report difficulty fully extending their fingers, particularly when trying to lay their hand flat on a surface.
• Hand Function Impairment: As the contracture progresses, patients may experience challenges with gripping, holding objects, or performing tasks that require fine motor skills.
• Pain or Discomfort: While Dupuytren's contracture is typically not painful, some patients may experience discomfort or a sensation of tightness in the palm or fingers.

Patient Characteristics

Dupuytren's contracture is more prevalent in certain populations, and several patient characteristics are associated with the condition:

1. Age: The condition is most commonly seen in adults, particularly those over the age of 50. The incidence increases with age.

2. Gender: Men are significantly more likely to develop Dupuytren's contracture than women, with a male-to-female ratio of approximately 3:1 to 12:1, depending on the population studied.

3. Ethnicity: The condition is more prevalent in individuals of Northern European descent, particularly those of Scandinavian or Celtic ancestry.

4. Family History: There is a strong genetic component to Dupuytren's contracture, with a higher incidence observed in individuals with a family history of the condition.

5. Associated Conditions: Dupuytren's contracture is often associated with other conditions, such as diabetes mellitus, epilepsy, and liver disease. Patients with these conditions may have a higher risk of developing Dupuytren's contracture.

6. Occupational Factors: Certain occupations that involve repetitive hand use or manual labor may increase the risk of developing Dupuytren's contracture, although the exact relationship remains unclear.

Conclusion

Dupuytren's contracture (ICD-10 code M72.0) is a progressive condition characterized by the thickening of the palmar fascia, leading to finger flexion deformities. Its clinical presentation includes palmar nodules, cord formation, and limited finger extension, with symptoms that can significantly impact hand function. Understanding the patient characteristics, including age, gender, ethnicity, and associated conditions, is crucial for early diagnosis and management. Early intervention can help mitigate the functional limitations associated with this condition, making awareness and recognition essential for healthcare providers.

Palmar fascial fibromatosis, commonly known as Dupuytren's contracture, is a condition characterized by the thickening and shortening of the palmar fascia, leading to the bending of fingers towards the palm. The ICD-10 code for this condition is M72.0. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Dupuytren's Contracture: This is the most widely recognized name for the condition, named after the French surgeon Guillaume Dupuytren, who first described it in the 19th century.

2. Palmar Fibromatosis: This term emphasizes the fibrous nature of the tissue involved in the condition.

3. Dupuytren's Disease: This term is often used interchangeably with Dupuytren's contracture, although it can refer to the broader spectrum of the disease, including its progression and associated symptoms.

4. Palmar Fascial Fibromatosis: This is a more technical term that describes the specific fibromatosis affecting the palmar fascia.

5. Fasciitis: While this term generally refers to inflammation of the fascia, it can sometimes be used in discussions about Dupuytren's due to the fibrous tissue involvement.

Related Terms

1. Contracture: This term refers to the permanent tightening of muscles, tendons, ligaments, or skin, which can occur in Dupuytren's contracture as the condition progresses.

2. Fasciotomy: A surgical procedure that may be performed to relieve tension in the fascia, often considered in severe cases of Dupuytren's contracture.

3. Collagenase Injection: A treatment option for Dupuytren's contracture that involves injecting an enzyme to help break down the thickened tissue.

4. Surgical Release: A common treatment for advanced Dupuytren's contracture, where the affected tissue is surgically removed to restore finger function.

5. Fibromatosis: A broader term that refers to a group of conditions characterized by the proliferation of fibrous tissue, which includes Dupuytren's contracture.

6. Plantar Fibromatosis: While primarily affecting the plantar fascia of the foot, this condition is related in that it involves similar fibrous tissue changes.

Understanding these alternative names and related terms can help in recognizing the condition in various medical contexts and discussions. If you have further questions or need more specific information, feel free to ask!

The diagnosis of Palmar fascial fibromatosis, commonly known as Dupuytren's contracture, is guided by specific clinical criteria that help healthcare providers determine the appropriate ICD-10 code, specifically M72.0. Below are the key criteria and considerations used in the diagnosis of this condition.

Clinical Presentation

Symptoms

• Nodules and Cords: Patients typically present with nodules in the palm, which may progress to form thickened cords that can pull the fingers into a flexed position.
• Limited Finger Extension: As the condition advances, patients may experience difficulty fully extending their fingers, particularly the ring and little fingers.

Physical Examination

• Palpation: A thorough examination of the palm is essential. The presence of palpable nodules or cords in the palmar fascia is a significant indicator.
• Table Top Test: This test assesses the ability to lay the hand flat on a surface. Inability to do so due to flexion deformities is a strong diagnostic sign.
• Total Passive Extension Test (TPET): This test measures the passive extension of the fingers. A significant difference between the passive extension and the active extension indicates the severity of the contracture.

Diagnostic Imaging

While imaging is not typically required for diagnosis, ultrasound or MRI may be used in complex cases to assess the extent of the fibromatosis and to rule out other conditions.

Exclusion of Other Conditions

It is crucial to differentiate Dupuytren's contracture from other conditions that may cause similar symptoms, such as:
- Trigger Finger: Characterized by locking or catching of the finger.
- Arthritis: Joint conditions that may also limit finger movement.
- Other Fibromatoses: Conditions affecting the fascia in different locations.

ICD-10 Code Assignment

Once the diagnosis is confirmed based on the above criteria, the appropriate ICD-10 code is assigned. For Dupuytren's contracture, the code is M72.0, which specifically refers to palmar fascial fibromatosis.

Conclusion

The diagnosis of Dupuytren's contracture involves a combination of clinical evaluation, physical examination, and the exclusion of other similar conditions. The presence of characteristic nodules, cords, and functional limitations in finger extension are critical in confirming the diagnosis and assigning the correct ICD-10 code M72.0. Proper diagnosis is essential for determining the appropriate treatment options, which may include surgical intervention or non-surgical management strategies.

Palmar fascial fibromatosis, commonly known as Dupuytren's contracture, is a condition characterized by the thickening and shortening of the palmar fascia, leading to the bending of fingers towards the palm. The ICD-10 code for this condition is M72.0. Treatment approaches for Dupuytren's contracture vary based on the severity of the condition, the degree of finger involvement, and the patient's overall health. Below, we explore the standard treatment options available.

Non-Surgical Treatments

1. Observation

In cases where the contracture is mild and does not significantly affect hand function, a conservative approach may be adopted. Regular monitoring is often sufficient, especially in early stages where the contracture does not impede daily activities.

2. Occupational Therapy

Occupational therapy can be beneficial for patients with Dupuytren's contracture. Therapists may provide:
- Stretching Exercises: To maintain finger mobility and prevent stiffness.
- Splinting: Night splints can help keep fingers extended, potentially slowing the progression of the contracture[1].

3. Collagenase Injection

Collagenase clostridium histolyticum is an FDA-approved injectable treatment for Dupuytren's contracture. This enzyme breaks down the collagen in the cords causing the contracture, allowing for improved finger extension. The procedure typically involves:
- Injection of collagenase into the affected cord.
- Follow-up manipulation of the finger to break the cord after a specified waiting period[2][3].

4. Needle Aponeurotomy

This minimally invasive procedure involves using a needle to puncture and divide the thickened fascia. It is performed under local anesthesia and can provide immediate improvement in finger extension. The recovery time is generally shorter compared to surgical options[4].

Surgical Treatments

1. Fasciectomy

For more severe cases, surgical intervention may be necessary. Fasciectomy involves the surgical removal of the affected fascia. This procedure is typically recommended when:
- The contracture is significant (usually more than 30 degrees at the proximal interphalangeal joint).
- Non-surgical treatments have failed or are not appropriate[5].

2. Dermofasciectomy

In cases where Dupuytren's contracture is recurrent or severe, dermofasciectomy may be performed. This involves the removal of both the affected fascia and the overlying skin, often followed by skin grafting. This approach aims to reduce the risk of recurrence[6].

Post-Treatment Care

Regardless of the treatment approach, post-treatment rehabilitation is crucial. This may include:
- Physical Therapy: To regain strength and flexibility in the hand.
- Follow-Up Appointments: To monitor for recurrence and manage any complications.

Conclusion

The treatment of Dupuytren's contracture (ICD-10 code M72.0) is tailored to the individual patient, considering the severity of the condition and the impact on hand function. Non-surgical options like observation, occupational therapy, collagenase injections, and needle aponeurotomy are effective for many patients, while surgical options are reserved for more advanced cases. Ongoing research continues to refine these treatment modalities, aiming to improve outcomes and reduce recurrence rates. If you or someone you know is experiencing symptoms of Dupuytren's contracture, consulting a healthcare professional is essential for an accurate diagnosis and appropriate treatment plan.