What Is Dupuytren's Contracture? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Dupuytren's contracture is a pulling in of the fingers toward the palm. It's caused by a shortening and thickening of the fascia — the fibrous layer of connective tissue that lies underneath the palm and the base of the fingers.

The tissue thickens and forms into lumps, or knots. Then it acts like a cord, pulling the fingers inward toward the palm.

Dupuytren's contracture most often affects the ring and pinky fingers. The right hand is affected twice as often as the left. About 80 percent of people with Dupuytren's contracture have it in both hands. Eventually the condition can make it difficult to fully straighten the affected fingers and do things like picking up objects or shaking hands.

The first sign may be a thickening of the skin on the palm of your hand. Eventually, hard lumps called nodules form under the skin of the palm or at the base of the fingers.

The nodules may eventually get thicker and turn into cords of tissue under the skin.

Usually, Dupuytren's affects the ring finger and/or pinky finger, but other fingers may be involved. One or both hands can be affected, but one hand is usually more severe than the other.

The more the fingers pull in, the harder it will become to straighten them.

Other symptoms include:

• Being unable to place the hand flat, palm-down on the table
• Pits or dips in the skin of the palm
• Difficulty moving the hand
• Lumps and cords in the soles of the feet (called plantar fibromatosis), the back of the hands (called Garrod disease), or the genitals (called Peyronie's disease)

Although the cause isn't known, Dupuytren's contracture is thought to run in families, which suggests that genes may be involved.

You may be more likely to develop this condition if you:

• Are age 50 or older
• Are male
• Have a family history of Dupuytren's contracture
• Are of Scandinavian (Swedish, Norwegian, Finnish) or northern European (English, Irish, Scottish, French) descent
• Have diabetes
• Take medicine to treat seizures
• Smoke tobacco or use alcohol to excess

Your doctor will start by going over your medical history. Because this condition often runs in families, you may be asked if you have any family members with Dupuytren's contracture.

Doctors can often diagnose Dupuytren's contracture just by examining your hand for the hallmark thickening and knots. One common test involves putting your hand palm-down on a table. The inability to flatten the hand is one sign of Dupuytren's contracture.

You may also have tests of:

• Feeling in your thumb and fingers
• Hand flexibility
• Grip and pinch strength
• Range of motion in your fingers

The doctor might use a special tool to measure how much your fingers are contracting. These measurements may be repeated and compared to assess your progress over time, and see whether your treatment is working.

X-rays are usually not needed. However, they may be done to rule out another condition, such as arthritis, that can affect range of motion.

Prognosis of Dupuytren's Contracture 

Dupuytren's contracture progresses very slowly over a period of years. The prognosis depends on how severe the disease becomes. Some people never have more than a few lumps in their palms. Others develop more severe contractures that make it difficult to straighten their fingers or hold on to objects.

Severe Dupuytren's contracture can interfere with activities of daily living. Some people may develop related conditions such as Peyronie’s disease, which causes a bend in the penis, or plantar fibromatosis, which affects the bottoms of the feet.

There is no known cure for Dupuytren's contracture. However, the condition usually progresses very slowly over many years. Some people live with only minor effects for the rest of their lives. Others have surgery to remove the contracture, although it can return.

If the contractures don't hurt and they aren't affecting your daily life, you may not need treatment. The doctor will perform follow-up exams every six months to see if the contracture has worsened.

Injections, surgery, and other treatments can slow the progression of Dupuytren's contracture and relieve symptoms.

Surgery

Needle Aponeurotomy This minimally invasive procedure, which means it requires only a small incision, and is mainly used for mild contractures. It can be done in the doctor's office, and the recovery is usually quick.

The doctor inserts a needle into the skin to break up the affected tissue. Afterward, you wear a splint to extend the finger. This technique can be done only on certain fingers because there is a risk of damaging a nerve or tendon with the needle. The condition returns within five years in 75 percent or more of people who have needle aponeurotomy.

Very Limited Fasciectomy The surgeon makes small incisions in the palm and removes the part of the cord that is causing the contracture so that you can straighten the finger more easily. You will receive local anesthesia to keep you comfortable.

The advantages to this procedure are that it is less invasive than open surgery, and the recovery takes only two to three weeks. However, Dupuytren's returns in up to 38 percent of cases.

Limited Fasciectomy In this procedure, the surgeon removes all of the cord that is causing the contracture. This has been the most common procedure used to treat Dupuytren's contracture. Most people who have a limited fasciectomy are happy with the results.

The downsides are that rehabilitation can take four to six weeks. There may be complications like finger stiffness, not just in the finger that was operated on, but in others as well. Some people have increased sensitivity to cold. Less often, nerve injury occurs. Dupuytren's returns in about 20 percent of cases within five years after the procedure.

Total Fasciectomy This procedure isn't performed as often because it is very invasive. The surgeon removes not only the contracture, but also some of the fat and skin in the palm over that area. A skin graft, usually taken from the arm, is used to cover the wound. Because the rate of recurrence is thought to be lower with this procedure, it may be an option for young people.

Surgery can cause complications like chronic pain, scarring, infection, and nerve injury. You may need physical therapy for several weeks after the procedure to regain movement in your hand.

Most people can move their fingers more easily after surgery, but it isn't a cure. Because the tissues can regrow, between 20 and 50 percent of people will have a recurrence, which may require a second procedure to fix.

Medication Options

Steroids are strong medications that bring down inflammation and relieve pain. Injecting corticosteroids into a lump can relieve pain and may slow progression of the contractures in some people.

However, the painful nodules return in up to 50 percent of people who get steroid injections. And side effects include skin color changes and sometimes rupture of the tendons in the hand.

Collagenase clostridium histolyticum (Xiaflex) is an enzyme that gradually breaks down and dissolves the contracture to make it easier to remove with surgery. The doctor injects collagen into the cord with a needle. Then the affected fingers are moved for several hours. Wearing a splint at night helps with straightening.

Collagenase injections can reduce contractures by 75 percent, but they return in 35 percent of cases. Side effects include swelling, skin tears, tendon rupture, and a type of chronic pain called complex regional pain syndrome (CRPS).

Other treatments have been studied, including botulinum toxin (Botox), and the cancer drugs tamoxifen, imiquimod, and 5-fluorouracil. There is no evidence that any of these treatments are effective.

Radiation

Radiation therapy may help slow the progression of Dupuytren's contracture in the early stages and can be used when deformities are mild to moderate. Radiotherapy is often well tolerated. However, this treatment can cause side effects such as skin reactions and dryness. It is important to balance the benefits and risk when considering this treatment.

Alternative and Complementary Therapies

Wearing a splint stretches the fingers and may improve the ability to straighten them. After surgery, physical therapy, and night splinting can aid in recovery. However, there is a risk that splinting might injure the finger or hand.

Prevention of Dupuytren's Contracture 

When the fingers bend inward, it may become more difficult to do things like grasp objects or shake hands. Because the thumb and index finger aren't often affected, it's usually still possible to write and do other fine motor activities.

Surgery can cause complications such as:

• Infection
• Nerve damage
• Tissue death (necrosis) around the edges of the wound
• Bruising
• Swelling
• A flare reaction, which includes swelling, redness, increased sensitivity, and stiffness in the finger

Men are up to 4 times more likely to have Dupuytren's contracture than women, and they have a more severe form of the condition. The likelihood of developing Dupuytren's increases with age.

People with Dupuytren's contracture are more likely to develop these conditions:

• Garrod's pads on the knuckles
• Ledderhose disease
• Adhesive capsulitis, or frozen shoulder
• Peyronie's disease (in males)

Dupuytren Foundation

This organization develops new treatments for Dupuytren's disease and related conditions. On its website, you can learn about Dupuytren's and enroll in research trials.

American Society for Surgery of the Hand

If you need surgery to correct Dupuytren's contracture, this website offers a searchable directory of surgeons across the United States and Canada.

International Dupuytren Society

On this website, you'll find background about Dupuytren's contracture and related diseases. There is also a forum where you can share information and learn from other people who have this condition.