The condition, Dupuytren's contracture, is progressive and means the tendons on the palm become stiff in a way that bends fingers toward the palm. 

The sooner it is detected, the better control is possible over the condition to slow it down. 

For diagnosing Dupuytren's contracture, doctors usually perform a physical exam and review medical history. They look for characteristic signs of the condition. Let's see how doctors diagnose Dupuytren's contracture now.

Spotting Early Signs

Dupuytren's contracture, mostly, starts with minimal symptoms that patients may overlook. Some of the early symptoms are:

Lump or nodule:

One of the first symptoms of Dupuytren's contracture will be small, hard lumps or nodules in the palm, often at the base of the fingers. The lump is usually not painful, but sometimes is tender.

Skin Pitting:

As the disease progresses, the palmar skin may develop pits or dimples. This happens because the tissue beneath the skin becomes thickened.

Tautness in the Skin:

The skin of the palm can become tight as the condition worsens with time.

Should these preliminary symptoms occur, it is necessary to seek medical opinion for assurance whether they are manifestations of Dupuytren's contracture or not.

Physical Check-up

Dupuytren's contracture diagnosis depends mainly on a proper, detailed physical check of the hand. In performing such a check, the doctor looks for several important signs, including:

Nodules and Cords:

The physician will examine the hand to detect nodules or cords of dense tissue beneath the skin. These cords may draw the fingers inward toward the palm, thus creating the characteristic contracture.

Finger movement:

The doctor would ask the patient to move their fingers around and could examine how easily the fingers could be straightened. In the early stages of the condition, the fingers are still able to straighten but in advanced cases, it is harder for the fingers to be extended.

Tabletop Test:

One of the more common tests for Dupuytren's contracture is called the "tabletop test." The patient places their hand flat on a table. If one or more fingers cannot lie flat on the table because of the contracture, then this strongly suggests Dupuytren's contracture. Being unable to flatten the entire hand is a classic sign of the condition.

Health History

The doctor will also take a comprehensive medical history besides the physical exam to determine how likely Dupuytren's contracture is. Such questions may include:

Family History:

As the case of Dupuytren's contracture tends to be hereditary, a family history may increase the risk factor for diagnosis.

Risk Factors:

The physician will likely ask about the identified risk factors to Dupuytren's contracture. These risk factors include a history of alcoholism, diabetes, or epilepsy because these conditions are associated with a greater chance of developing the disease.

History of Progression of Symptoms:

The development speed of the symptoms informs on the severity and progression of the disease. Slow development signifies a milder form of the disease, while rapid changes indicate a more serious case.

Phases of Dupuytren's Contracture

According to the severity of the contracture, the condition can be staged into different levels:

Early stage:

The small lumps are formed on the palms, but they hardly affect the movement of the fingers.

Intermediate Stage:

Development of strings, which at first beginning starts to pull the fingers towards the palm but can, however, be straightened.

Advanced Stage:

The fingers are unable to be stretched flat, as they tend to be bent toward the palm. The hand may be severely impaired in its functioning and probably is best treated surgically.

The physician will determine the stage of the disease he should treat by checking how far the disease has progressed.

Are Imaging Tests Required?

Most of the time, doctors don't require any imaging tests such as X-rays, MRI, or ultrasound to be able to diagnose Dupuytren's contracture. 

The usual physical signs guide diagnosis. Imaging tests may be required, however, in a few instances where the diagnosis is obscure or if the doctor believes that some other problems might exist. 

For example, if there are concerns about arthritis or any other issues with the joint, a doctor may use an X-ray to analyze any other cause of the hand deformation.

Differential Diagnosis

There are other hand problems that produce similar signs, so the physician should evaluate these when making a diagnosis of Dupuytren's contracture. 

Among the problems that may be confused with Dupuytren's contracture include:

Trigger Finger:

A condition in which a finger locks into a flexed position because of inflammation of the tendons. 

In contrast with Dupuytren's contracture, trigger finger is often painful and may be associated with clicking with movement.

Tenosynovitis:

Tenosynovitis causes swelling of the tendons in the hand. The condition leads to stiffness and pain but does not give the formation of a mass or a cord.

Arthritis:

The joint stiffness and deformity caused by arthritis resemble Dupuytren's contracture, but arthritis generally includes pain and swelling in joints.

A careful check-up by an experienced doctor will most likely differentiate Dupuytren's contracture from these and other diseases.

When to consult a Specialist

In certain situations, especially where the condition is quite severe or daily activities are affected, a visit to a specialist hand doctor or an orthopedic surgeon would be wise. 

A hand specialist can more aggressively treat the patient with injections, needle aponeurotomy, or surgery depending on how bad the disease is.

Monitoring and Follow-Up

Since Dupuytren's contracture is a disease that generally worsens over time, one should follow up regularly with a healthcare professional to monitor the progression of the disease and make sure that the onset of treatment occurs appropriately. 

For those in the early phases of developing Dupuytren's contracture, monitoring may include routine checks to see if the contracture is worsening or if hand movements become more difficult.

Conclusion

Diagnosis of Dupuytren's contracture is typically done by clinical presentation, medical history, and other special tests like the tabletop test. 

However, though the symptoms of the disease at its initial stages are minor, for effective control and prevention of escalation, it is crucial to seek medical attention early when the condition first manifests. 

Patients with Dupuytren's contracture can explore treatments that preserve hand function and minimize interference with daily activities when the very first symptoms are when people seek a doctor.