Dupuytren's Contracture

Overview

Dupuytren's contracture is a condition that affects the layer of tissue under the skin of the palm, called the fascia. Over time this tissue thickens and forms tight cords that can pull one or more fingers toward the palm, making it hard to straighten them fully. The ring and little fingers are most often affected.

The condition usually develops slowly over years and is generally painless. In its early stages it may cause only a small lump or dimpling in the palm. As cords form and tighten, the fingers become increasingly bent. Dupuytren's is not dangerous, but in advanced cases it can interfere with everyday tasks such as putting on gloves, shaking hands, or placing the hand flat on a surface.

Symptoms

Dupuytren's contracture tends to progress gradually, and symptoms may include:

• A small, firm lump or nodule in the palm, often near the base of the ring or little finger
• Puckering or dimpling of the skin of the palm
• Thick cords of tissue that develop under the skin, extending toward the fingers
• One or more fingers slowly bending toward the palm and becoming difficult to straighten
• Difficulty laying the hand flat on a table (a simple way people notice the problem)

The condition is usually painless, though the nodules can occasionally feel tender. It often affects both hands, though not always equally.

Causes

The exact cause of Dupuytren's contracture is not known. It is not caused by injury or by manual work, although it sometimes appears after hand trauma. The thickening results from an overgrowth of the fascia in the palm, but why this happens is not fully understood.

Genetics play a strong role, and the condition often runs in families, particularly those of Northern European ancestry. Because of this hereditary link it is sometimes called Viking disease. Certain health conditions and habits are associated with a higher risk, but they do not directly cause it.

Risk Factors

• Older age, with the condition becoming more common after 50
• Male sex, as men are affected more often and more severely
• Northern European ancestry
• A family history of Dupuytren's contracture
• Smoking and heavy alcohol use
• Diabetes

Diagnosis

Dupuytren's contracture is usually diagnosed with a physical examination, and tests are rarely needed:

• Examination of the hand: The doctor feels the palm for nodules and cords and checks how far the fingers can be straightened.
• Tabletop test: Trying to lay the hand flat on a table; if it cannot lie flat, this supports the diagnosis and tracks progression.
• Measuring finger movement: Recording the degree of bending helps decide whether and when treatment is needed.

Because the appearance is distinctive, imaging or biopsy is seldom required.

Treatment

Treatment depends on how much the contracture limits hand function. Mild cases without much bending often just need monitoring.

• Observation: Early, mild disease that does not affect daily activities may simply be watched over time.
• Needle aponeurotomy: A needle is used to puncture and divide the tight cord, allowing the finger to straighten, done under local anesthesia.
• Enzyme injection: An injection that helps break down and weaken the cord so it can be released.
• Surgery: Removing or dividing the thickened tissue, used for more advanced contractures; recovery often includes hand therapy.

No treatment cures the underlying tendency, so contractures can return over time and further treatment is sometimes needed.

Prevention

There is no proven way to prevent Dupuytren's contracture, since it is largely inherited. Some general measures may help and are good for overall health:

• Avoid smoking
• Limit alcohol
• Manage diabetes well if you have it
• See a doctor early if you notice changes, so treatment can be planned before severe bending develops

When to See a Doctor

See a doctor if you notice a lump, dimpling, or thickening in your palm, or if a finger is starting to bend toward the palm and you cannot fully straighten it. A simple sign to watch for is being unable to lay your hand flat on a table.

Early evaluation allows the condition to be monitored and treated before the bending becomes severe enough to interfere with daily tasks such as gripping, shaking hands, or wearing gloves.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Dupuytren's contracture — Symptoms and causes.
2. American Academy of Orthopaedic Surgeons (AAOS). Dupuytren's Disease.
3. MedlinePlus, U.S. National Library of Medicine. Dupuytren contracture.
4. American Society for Surgery of the Hand.