Dupuytren's Contracture

What Is Dupuytren's Contracture?

Dupuytren's contracture is a disorder of the palm where the fascia, a layer of fibrous tissue just beneath the skin, becomes abnormally thick. Normally, this fascia covers and protects the nerves, blood vessels, muscles, and tendons of your hand while helping to stabilize the skin. In Dupuytren's disease, the fascia thickens and forms rope-like cords that can pull your fingers toward your palm.

These cords are often mistaken for tendons because they look and feel similar, but unlike tendons that move your fingers by muscle contraction, the cords in Dupuytren's are static. They don't move on their own and exist only to contract and pull. Most people with this condition also develop nodules or bumps in the palm. Over time, these nodules and cords may grow larger and thicker, gradually drawing the fingers into a bent position that makes it impossible to fully straighten them.

Symptoms

Symptoms of Dupuytren's contracture usually include firm lumps, nodules, and thick bands or cords on the palm side of your hands. These lumps are typically stuck to the overlying skin, which may appear thicker and puckered. Some areas of skin may be swollen and puffy like a speed bump, while others are dimpled and pulled down like a pothole.

The ring finger and little finger are most commonly affected, though the condition can involve one or both hands, often in different patterns and at different times. While the lumps can be uncomfortable in some people, Dupuytren's contracture is typically not painful. You may first notice the problem when you have difficulty placing your hand flat on a surface or when you can't fully open your hand. Everyday tasks like washing your hands, wearing gloves, holding large objects, or reaching into pockets may become more difficult. When it affects the dominant hand, even simple activities like shaking hands can feel awkward.

Causes & Risk Factors

The exact cause of Dupuytren's contracture is unknown and likely involves complex interactions between genetic and environmental factors. It is a hereditary disease, meaning family history and ancestry play significant roles. The condition is more common in men, people over age 40, and those of Northern European descent. It occurs less frequently in people of African and Middle Eastern backgrounds.

Several other factors are associated with Dupuytren's including smoking, diabetes, alcohol use, lower body mass index, and aging. There is no evidence that hand injuries or specific jobs cause the condition, though there may be a mild relationship to trauma in someone already genetically predisposed. Occasionally, after a wrist fracture, a patient may develop a single nodule in the palm that may or may not progress.

The disease can be more aggressive in certain situations. If you develop Dupuytren's at a younger age, if you have many affected relatives, or if the disease shows up in other parts of your body, you may be at higher risk for severe contractures. Related conditions include lumps and cords on the soles of the feet, thickening on top of the knuckles, or similar changes in other areas of the body.

Diagnosis

The presence of a lump in your palm doesn't automatically mean treatment is needed or that the condition will progress. Not all lumps in the palm are Dupuytren's, so seeing a hand surgeon for an examination can provide clarity. Sometimes a history and examination are all that's needed to evaluate a mass. Other times, imaging such as an x-ray, ultrasound, or MRI may be indicated to look for other possible causes.

Important factors in evaluating palm masses include their size, how they feel (firm or soft), location, whether they're painful, how they move with the skin, family history, and other medical conditions. In mild cases, especially if hand function remains good, only observation is needed. The contracture may remain stable for years or may progress slowly or quickly. Predicting how the disease will behave in any individual is difficult.

Treatment Options

In mild cases where hand function is good, observation alone is appropriate. Splinting or stretching typically does not prevent worsening of the contracture, though it is safe to try. Treatment is usually considered when the contracture prevents you from laying your hand flat on a table or when it begins to interfere with your daily activities.

Non-surgical options include needle fasciotomy, an office procedure where a needle is used to cut through the cord in several places while you're awake under local anesthesia. The hand is then gently stretched to break the cord, allowing the finger to straighten. Recovery is quick, typically just a few days, though small tears in the skin may occur and need to heal. Another option is collagenase injection, an enzyme that dissolves the cord over a day or two before it's stretched and broken in a follow-up visit. Both procedures are less invasive but may result in the cord returning over time, with about one-third of patients seeing recurrence.

Surgical treatment involves either cutting the cords (fasciotomy) or removing the diseased tissue entirely (fasciectomy). Surgery can be performed under local anesthesia, with sedation available for select cases if needed, and you'll go home the same day. The more extensive the surgery, the longer the recovery but potentially the better the long-term results. Your hand surgeon will discuss which approach is most appropriate based on the stage and pattern of your disease.

Surgery: What to Expect

For patients choosing surgical fasciectomy, the procedure is performed as an outpatient surgery under local anesthesia, with sedation available for select cases if needed. The surgery involves making incisions in the palm and fingers to carefully remove the diseased fascia, cords, and nodules. Sometimes portions of skin affected by the disease may need to be removed as well. Because of the extent of tissue removed, some bleeding on the dressings during the first few dressing changes is normal.

After surgery, your hand and fingers are usually much straighter, though full correction may not always be possible. It's important to understand that Dupuytren's disease is not fully curable, and nodules and cords may return over time in the same or different locations. Your surgeon will discuss realistic expectations and potential risks before treatment.

Recovery

Recovery from fasciectomy surgery typically takes about six weeks. During this time, your hand can be used for light activities, but you'll need to set aside time multiple times per day to perform exercises and possibly use a splint. You'll receive a home exercise program that includes finger motion exercises and techniques to improve function. While most people manage recovery well with these home exercises, hand therapy is available if needed for more complex cases.

Starting exercises and therapy soon after surgery leads to the best results. Waiting weeks or months to begin can result in stiffness that's harder to overcome. The more effort you put into your recovery in the early weeks, the better your final outcome will be. Most people regain good hand function, though some may experience residual stiffness or limitations depending on how severe the contractures were before surgery.

When to See a Specialist

If you're noticing lumps in your palm, difficulty straightening your fingers, or trouble with everyday hand tasks, it's worth getting evaluated. Early assessment can help you understand what to expect and what treatment options are available. Not everyone with Dupuytren's needs treatment right away, but having a baseline evaluation gives you information to make informed decisions as the condition changes over time.

Dr. Lackey specializes in diagnosing and treating Dupuytren's contracture and can help determine whether observation, minimally invasive procedures, or surgery is the right choice for your situation. An evaluation can provide clarity and a path forward tailored to your specific needs and lifestyle.