Dupuytren’s Contracture
What Is Dupuytren’s Contracture? Causes, Symptoms & Treatment Options
Dupuytren’s contracture is a progressive condition of the hand that affects the palmar fascia, a layer of connective tissue beneath the skin of the palm. Over time, this tissue thickens and shortens, forming firm cords that can pull one or more fingers toward the palm and make them difficult to straighten.
The ring and little fingers are most commonly involved. The middle finger may also be affected, while the thumb and index finger are less commonly involved. As the condition progresses, everyday activities such as gripping objects, typing, or shaking hands may become more difficult.
Dupuytren’s is often not painful, but some people have tender or painful nodules or hand discomfort. It can significantly impair hand function if the contractures become advanced.
What Causes Dupuytren’s Contracture?
The exact cause of Dupuytren’s contracture is not fully understood. Research suggests it involves abnormal collagen production and increased activity of specialized cells called myofibroblasts, which cause the palmar fascia to thicken and tighten over time.
Several factors increase the risk of developing Dupuytren’s contracture, including:
- Age: Most commonly develops after age 50
- Gender: More common in men than women
- Family history: Often runs in families
- Ancestry: More frequent in individuals of Northern European or Scandinavian descent
- Lifestyle factors: Smoking and heavy alcohol use
- Medical conditions: Diabetes and other associations have been reported (e.g., seizure disorders/antiepileptic use), but evidence varies.
Symptoms of Dupuytren’s Contracture
Dupuytren’s contracture usually develops slowly over the years. Common signs and symptoms include:
- Firm nodules or lumps in the palm
- Thickened cords beneath the skin
- Gradual bending of one or more fingers toward the palm
- Difficulty fully straightening affected fingers
Pain is uncommon. Many patients develop significant finger contracture without discomfort, which can delay evaluation or treatment.
How Dupuytren’s Contracture Is Diagnosed
Diagnosis is typically made based on a physical examination and medical history. Your provider will assess the palm and fingers for nodules, cords, and limitations in finger extension.
Common evaluation methods include:
- Tabletop test: Difficulty placing the hand flat on a surface suggests a functional limitation
- Palpation: Identifying firm cords or nodules in the palm
Imaging studies are rarely required, as Dupuytren’s contracture is usually diagnosed clinically.
Dupuytren’s Contracture Treatment Options
Not all cases require immediate treatment. If finger bending does not interfere with hand function or daily activities, observation may be appropriate.
Treatment is generally considered when finger contracture:
- Interferes with work or daily tasks
- Prevents the hand from lying flat
- Causes functional limitation, even in the absence of pain
For More Information
Observation and Supportive Care
These approaches may help with comfort but do not stop disease progression or correct contracture:
- Heat therapy: May improve comfort before movement
- Gentle massage: Can help with local tenderness
- Stretching exercises: May help maintain mobility, but do not reverse or prevent contracture
Minimally Invasive Office-Based Treatments
Steroid Injections
Steroid injections may be used in early stages to reduce pain or tenderness associated with nodules. They do not correct finger contracture or stop disease progression.
Collagenase Injections
Collagenase is an enzyme injected directly into the Dupuytren’s cord to weaken the abnormal tissue. The finger is then gently manipulated to help release the contracture. This option may be appropriate for select patients and specific cord patterns.
Needle Aponeurotomy
Needle aponeurotomy is a minimally invasive procedure in which a fine needle is used to divide the tightened cords beneath the skin, allowing improved finger extension. Imaging guidance is typically not required and is used only in select situations.
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