Medically reviewed by: Mark A. Yaffe(opens in a new tab), MD — Board-Certified Orthopedic Surgeon, Subspecialty Certified in Hand Surgery
Key Takeaways
- Dupuytren's contracture is a thickening of the tissue under the skin of the palm that forms lumps and cords and gradually pulls one or more fingers, most often the ring and little fingers, toward the palm.
- It is usually painless and slow to progress, and it can't be cured, but treatment can straighten the finger and restore hand function.
- Mild cases without a bent finger are often simply watched, and treatment is typically considered when the finger can't be straightened enough to lay the hand flat or the contracture is getting worse.
- Options include needle aponeurotomy, collagenase injection, and surgery, with the less invasive options recovering faster but more likely to recur, and surgery tending to give longer-lasting correction.
- Seeing a hand surgeon before the middle joint of the finger becomes severely bent matters, because advanced contractures are harder to correct fully.
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What Is Dupuytren's Contracture?
Dupuytren's contracture, also called Dupuytren's disease, is a condition in which the tissue just under the skin of the palm, called the palmar fascia, thickens and tightens. It forms firm lumps and then cords that gradually pull one or more fingers toward the palm so they can't be fully straightened. The ring and little fingers are affected most often.
The condition is usually painless, and it develops slowly, sometimes over years. Treating it is one part of broader hand and wrist(opens in a new tab) care. Because it involves the tissue beneath the skin rather than the tendons or joints, it is different from problems such as trigger finger(opens in a new tab), even though both can make a finger hard to straighten.
What Causes Dupuytren's Contracture, and Who Is at Risk?
The exact cause isn't known, but genetics clearly play a role, and the condition often runs in families. Dupuytren's contracture is more common in the following groups:
- Men, and people over age 40 to 50
- People of Northern European ancestry
- People with a family history of the condition
- People with diabetes
- People who smoke or drink alcohol heavily
- People who take certain seizure medications
Dupuytren's can affect both hands, and some people also develop thickened tissue on the knuckles or the soles of the feet. It isn't caused by an injury, and the evidence that hand work causes it is weak.
Symptoms of Dupuytren's Contracture
Dupuytren's contracture tends to develop gradually, and symptoms often include:
- A firm lump or nodule in the palm, sometimes slightly tender at first
- Pitting or dimpling of the skin of the palm
- A thick cord under the skin that extends from the palm toward a finger
- A finger, most often the ring or little finger, that gradually curls toward the palm
- Difficulty putting on gloves, shaking hands, washing your face, or placing the hand flat on a table or into a pocket
A simple self-check is the tabletop test. If you can't lay your palm and fingers flat on a table, the contracture may have progressed far enough to need evaluation. Unlike many hand conditions, Dupuytren's usually causes stiffness and curling rather than pain.
How Is Dupuytren's Contracture Diagnosed?
Dupuytren's contracture is usually diagnosed from a hands-on exam alone. A hand surgeon looks for nodules and cords in the palm, measures how many degrees each finger joint is bent, and performs the tabletop test. Imaging isn't usually needed.
Other conditions can cause a bent finger or a lump in the palm and are worth ruling out, including finger arthritis(opens in a new tab), which stiffens the joints themselves, and hand masses(opens in a new tab), such as a ganglion cyst(opens in a new tab). A locking finger that catches and snaps, rather than slowly curling, points more toward trigger finger.
Non-Surgical Treatment for Dupuytren's Contracture
There is no medication, stretching routine, or splint that dissolves the cords, so treatment depends on how bent the fingers are. Common approaches include:
- Observation: When there are lumps or cords but the fingers still straighten fully, the condition is often just monitored, because it may progress slowly or not at all.
- Needle aponeurotomy: A needle is used through the skin, under local anesthesia, to weaken and break the cord so the finger can be straightened. Recovery is quick, but the cord is more likely to return than after surgery.
- Collagenase injection: An enzyme is injected into the cord to weaken it, and the finger is straightened by the surgeon, usually within a day or so. It can be an option for selected patients, though recurrence is also more common than after surgery.
- Hand therapy and splinting: After a procedure, therapy and a night splint may be used to help maintain the straightening.
Treatment is usually considered once the knuckle at the base of the finger is bent about 30 degrees or more, once the middle joint of the finger is bent at all, or when the contracture is clearly getting worse. These are general guidelines rather than strict rules, and the right timing depends on how much the finger limits what you do.
Surgery for Dupuytren's Contracture
Surgery is generally recommended for more advanced contractures, for fingers that have bent again after other treatments, and when the cords are too complex for a needle or injection. In a fasciectomy, the surgeon opens the skin of the palm and finger, removes the diseased tissue, and releases the finger. In recurrent or severe cases, skin may need to be replaced with a graft. Surgery tends to give the longest-lasting correction, but it involves a longer recovery than the less invasive options.
Dupuytren's and trigger finger sometimes occur in the same hand, and the surgical options for the latter are covered in this article on trigger finger surgery(opens in a new tab).
What to Expect During Recovery
After surgery, the hand is placed in a bulky dressing and often a splint. Stitches are typically removed within 10 to 14 days, and hand therapy is usually started to restore motion and keep the finger straight. Light daily use often resumes within a couple of weeks, while heavier use and full motion can take several weeks to a few months, depending on how much tissue was removed and how stiff the finger was beforehand. A night splint is often used for a period afterward. For a general overview of what recovery involves, see this article on hand surgery recovery(opens in a new tab).
Risks and Recurrence
Complications are uncommon but can include nerve or blood vessel injury, infection, stiffness, delayed wound healing, and, rarely, a painful stiffening condition called complex regional pain syndrome. With collagenase and needle treatment, skin tears and, rarely, tendon injury can occur. Recurrence is the most common issue, because Dupuytren's is a chronic condition. Cords can return months or years after any treatment, and they return sooner after needle or injection treatment than after surgery. A recurrence can often be treated again.
When to See a Hand Surgeon
It's worth seeing a hand surgeon if you notice a cord or nodule in the palm, if a finger is beginning to curl, if you can't lay your hand flat on a table, or if the condition is getting in the way of everyday tasks. Treatment works best before the middle joint of the finger is severely bent, because long-standing contractures in that joint may not straighten fully even after the cord is released. A hand surgeon can confirm the diagnosis, measure how far each finger is bent, and walk through which options fit your situation. If you have also had pain or tenderness in the palm, this article on persistent hand pain(opens in a new tab) can help you decide when to be seen.
If you are looking for care, see this guide on how to find a hand specialist in Chicago(opens in a new tab), and this article explains when to seek hand specialist treatment(opens in a new tab) for fractures, tendon injuries, and nerve conditions. Dr. Yaffe sees patients in Schaumburg(opens in a new tab), Elk Grove Village(opens in a new tab), and Buffalo Grove(opens in a new tab). To get started, schedule an appointment(opens in a new tab) online, and it helps to note which fingers are affected and whether you can lay the hand flat.
Frequently Asked Questions
What causes Dupuytren's contracture?
The exact cause isn't known. The condition appears to be largely genetic, and it is more common in men, in people over 40, in people of Northern European ancestry, and in people with diabetes or a family history. Smoking and heavy alcohol use are also associated with it, but it isn't caused by an injury.
Does Dupuytren's contracture go away on its own?
No. Dupuytren's doesn't resolve on its own. Some people never progress beyond small lumps, while others develop fingers that curl over time. Because the course is hard to predict, it's worth having it monitored by a hand surgeon.
Is Dupuytren's contracture life-threatening?
No. Dupuytren's contracture isn't life-threatening and doesn't directly shorten life expectancy. It is a chronic condition that can affect hand function if it progresses, which is why treatment is aimed at keeping the fingers usable.
Is Dupuytren's contracture the same as trigger finger?
No. Dupuytren's involves thickened tissue under the skin of the palm that forms cords and gradually curls the fingers, usually without pain. Trigger finger involves a tendon catching in its sheath, which causes clicking, snapping, or locking of the finger.
Can Dupuytren's contracture come back after treatment?
Yes. Treatment straightens the finger but doesn't cure the underlying condition, so cords can return, sometimes years later. Recurrence is more common after needle or injection treatment than after surgery, and it can often be treated again.
