ConditionBones, joints & muscles
Dupuytren's Contracture
Dupuytren's contracture is a slowly progressive thickening of the tissue under the skin of the palm (palmar fascia). It starts as firm lumps (nodules), then forms cords that gradually pull one or more fingers, usually the ring and little fingers, into a bent position that will not straighten. It is usually painless, runs in families and is most common in men of Northern European descent over 50. Treatment is considered once the hand can no longer lie flat on a table.
Also called: Dupuytren's disease, palmar fibromatosis, Viking disease
At a glance
- What it is
- Thickening and tightening of the palm's connective tissue, forming nodules and cords.
- Fingers affected
- Ring and little fingers most often. Usually both hands, one worse.
- Risk factors
- Family history, Northern European ancestry, male sex, age over 50, diabetes, smoking, heavy alcohol use.
- Key test
- The tabletop test. If you cannot lay your palm flat, it is time to consider treatment.
- Treatment
- Needle fasciotomy, collagenase injection where available, or surgery (fasciectomy). Recurrence is common.
When to get help
Book a routine appointment
- A firm lump or pit in the palm that is new or growing
- A finger that is starting to bend and will not straighten fully
- Not being able to lay your hand flat on a table
- Difficulty putting on gloves, shaking hands or putting your hand in a pocket
- Painful palm nodules
Usually safe to manage at home
- A small, painless palm nodule with full finger movement, which can be watched
What happens in the hand
Under the palm skin lies a tough layer called the palmar fascia, which anchors the skin for gripping. In Dupuytren's, cells called myofibroblasts lay down excess collagen. This forms:
- nodules: firm lumps in the palm, often near the base of the ring finger, sometimes with skin pitting
- cords: tight bands running from the palm into the fingers
- contracture: the cords shorten, pulling the knuckle and middle joints of the finger into a bent position
The tendons themselves are not affected. Progression varies from very slow over decades to faster in some people.
Who gets it
- family history: strongly inherited, with dominant inheritance in many families
- ancestry: most common in people of Northern European (especially Scandinavian) descent, hence "Viking disease"
- men: more often and earlier than women
- age: usually over 50
- diabetes
- smoking and heavy alcohol use
- epilepsy and some antiseizure medicines
- hand injury or surgery can trigger it in susceptible people
Manual work has a weak link at most.
Related conditions
People with more aggressive disease (sometimes called Dupuytren's diathesis) may also have:
- thick pads over the knuckles (Garrod's pads)
- plantar fibromatosis (Ledderhose disease): nodules on the sole of the foot
- Peyronie's disease: curvature of the penis from similar scar tissue
Early onset, both hands affected, family history and these related conditions predict faster progression and higher recurrence after treatment.
Symptoms
- a firm, usually painless lump or pit in the palm
- tight cords running into the fingers
- one or more fingers bending toward the palm
- difficulty with tasks: putting on gloves, washing the face, handshakes, putting hands in pockets
- nodules can be tender early on
The thumb and index finger are less commonly involved.
Dupuytren's vs other conditions
| Condition | Key difference |
|---|---|
| Trigger finger | Finger catches or locks and clicks, can usually be straightened, often painful |
| Arthritis | Joint swelling and stiffness rather than a cord in the palm |
| Ganglion cyst | Smooth, fluid-filled lump, often at the wrist or finger base |
| Diabetic stiff hand | Thickened, waxy skin and limited movement of many fingers |
Diagnosis
Diagnosis is clinical. A doctor will feel the nodules and cords, measure the angle of each bent joint with a goniometer, and perform the Hueston tabletop test: placing the palm flat on a table. If it cannot lie flat, a referral to a hand surgeon is usually appropriate. Imaging is rarely needed.
Treatment
There is no cure, and treatment does not stop the underlying disease. It aims to straighten fingers and restore function. Early disease without contracture does not need treatment.
Watchful waiting
Many people have nodules for years without significant contracture. Monitor with the tabletop test.
Needle fasciotomy (percutaneous needle aponeurotomy)
Under local anesthetic, a needle is used to divide the cord through the skin. Recovery is quick, often days, but recurrence is more common than after surgery.
Collagenase injection
An enzyme injected into the cord softens it, and the finger is straightened by the doctor a day or so later. It has been used widely, though availability varies by country and over time.
Surgery
- Limited fasciectomy: removal of the diseased tissue through incisions in the palm and finger. It gives longer-lasting results but has a longer recovery of several weeks to months
- Dermofasciectomy: removal of overlying skin with a skin graft, for recurrent or aggressive disease
Hand therapy and splinting after treatment help maintain the correction.
Early-stage options
Radiotherapy for early nodular disease is offered in some centers, with mixed evidence. Steroid injections can soften painful nodules.
Risks and recurrence
Treatment risks include nerve injury, skin tears, infection, stiffness and complex regional pain syndrome. Recurrence over years is common with all treatments, especially in younger people with strong risk factors.
Outlook
Dupuytren's contracture is not dangerous and does not spread to other parts of the body in the way cancer does. Many people never need treatment. Those who do usually regain good hand function, although repeat treatment may be needed later.
Frequently asked questions
What causes Dupuytren's contracture?
The exact cause is unknown, but it is strongly genetic. It is more common in men, people of Northern European descent and those over 50. Diabetes, smoking, heavy alcohol use and some antiseizure medicines also increase risk.
What are the first signs of Dupuytren's contracture?
The first sign is usually a firm, painless lump or a small pit in the palm, often near the base of the ring finger. Over months to years, cords may form and slowly pull the finger into a bent position.
Can Dupuytren's contracture be cured?
No, but its effects can be treated. Needle fasciotomy, collagenase injection or surgery can straighten bent fingers and restore function. The condition can recur, sometimes needing further treatment years later.
When should Dupuytren's contracture be treated?
Treatment is usually considered when the hand can no longer lie flat on a table or when the bent finger interferes with daily activities. Small, painless nodules without contracture can be watched.
Do stretching exercises help Dupuytren's contracture?
Stretching does not stop the disease or reverse contracture, and forceful stretching may inflame nodules. Hand therapy and splinting are useful after treatment to maintain the improved finger position.
Sources
This guide was written from current patient and clinical guidance, including:
- American Society for Surgery of the Hand: Dupuytren's contracture
- American Academy of Orthopaedic Surgeons (OrthoInfo): Dupuytren's contracture
- NHS: Dupuytren's contracture
- British Society for Surgery of the Hand: Dupuytren's disease
- NICE: Needle fasciotomy and radiation therapy for early Dupuytren's disease (interventional procedures guidance)