Is Dupuytren’s Contracture?
Dupuytren’s contracture is a condition that causes nodules, or
knots, to build up underneath the skin of your fingers and palms. It can cause
your fingers to become stuck in place. It most commonly affects the ring and
little fingers and causes the proximal and middle joints, which are those closest
to your palm, to become bent and difficult to straighten. Treatment varies
depending on the severity of the nodules.
Are the Symptoms of Dupuytren’s Contracture?
Dupuytren’s contracture usually progresses very slowly. Often,
the first symptom is a thickened area on the palm of your hand. It may be
described as a lump or nodule and include small pits on your palm. The lump is
often firm to the touch, but it’s not painful.
Over time, thick cords of tissue extend from the lump. They
usually connect to your ring or pinky fingers, but they can extend to any
finger. These cords eventually tighten, and your fingers can become pulled into
The condition can occur in both hands, but usually one hand is
more severely affected than the other. Dupuytren’s contracture makes it
difficult to grasp large objects, wash your hands, or shake hands.
Causes Dupuytren’s Contracture and Who Is at Risk?
The cause of this disease is unknown, but your risk of developing
the condition increases if you:
- are male
- are between 40 and 60 years of age
- are of Northern European descent
- have a family history of the condition
- smoke or drink alcohol
- have diabetes
Overuse of your hands, such as from working in a job that
requires repetitive hand motions, and hand injuries don’t increase your risk of
developing this condition.
Your doctor will examine your hands for lumps or nodules. Your doctor
will test your grip, your ability to pinch, and the feeling in your thumb and
They’ll also perform the tabletop test, which requires you to put
the palm of your hand flat on a table. If you’re able to do this, you don’t
have the condition.
Your doctor may take measurements and record the location and
amount of contracture. They will refer to these measurements at future
appointments to see how quickly the condition is progressing.
There’s no cure for Dupuytren’s contracture, but there are
treatments available. You may not need any treatment until you’re unable to use
your hands for everyday tasks. Nonsurgical treatments are available, including
steroid injection, which can prevent progression of the contracture, and
In more severe or progressed cases, your doctor may recommend
surgery. Surgical treatment involves breaking up the cords that are pulling
your fingers in. The severity of your condition will determine the best course
Needling involves using a needle to break the cords apart. The
contracture often comes back, but the procedure can be repeated.
The advantages are that needling can be done multiple times and it
has very short recovery time. The disadvantage is that it can’t be used on
every contracture because the needle could damage nearby nerves.
Xiaflex, an injectable collagenase injection, weakens the cords.
Your doctor will manipulate your hand to try to break up the cord the day after
the injections are given. This is an outpatient procedure with a short recovery
The disadvantages are that it can be used on only one joint each
time and there’s a high recurrence of the fibrous bands. The treatments must be
at least one month apart.
Surgery removes the cord tissue, but it may need to be done at a
later stage when the cord tissue is identifiable. On occasion, it may be hard
to remove the cord without removing the attached skin.
This is a more permanent solution to the contracture. The
disadvantages of surgery are that it has a long recovery period and requires
physical therapy to return full hand movement and functionality. On rare
occasions, skin tissue may also be removed during the surgery, which requires a
skin graft to cover the area.
Some things you can do at home to ease your pain and other
- stretching your fingers away from your palm
- relaxing the contracture using massage and heat
- protecting your hands by using gloves and
avoiding gripping tightly when handling equipment
What Is the Long-Term Outlook for People with Dupuytren’s Contracture?
Dupuytren’s contracture isn’t life-threatening. You can work with
your doctor to determine which treatment options will work best for you. Learning
how to incorporate at-home treatments can help you manage your contracture.