Dupuytren contracture

Dupuytren contracture is a condition in which the tissue just under the skin of the palm, called the palmar fascia, slowly thickens and tightens. Firm lumps and then cord-like bands form, and over time the cords can pull one or more fingers into a bent position that cannot be fully straightened. It is not cancer, and it usually progresses slowly, often over years. The ring and little fingers are affected most often.

• Firm lumps (nodules) in the palm, sometimes with puckering or dimpling of the skin
• Thick, rope-like cords running from the palm into the fingers
• A finger, most often the ring or little finger, that gradually bends toward the palm and will not fully straighten
• Difficulty laying the hand flat on a table, putting on gloves, washing your face, or reaching into a pocket
• Usually little or no pain, although early nodules can be tender

It can appear in one hand or both. Some people develop similar thickening on the soles of the feet.

The cause is not fully understood, but genes play a strong role and the condition often runs in families. Hand overuse and manual work have not been shown to cause it.

Risk is higher with:

• Middle and older age
• Male sex; women tend to develop it later and less severely
• Northern European ancestry
• A family history of the condition
• Smoking and heavy alcohol use
• Diabetes
• Seizure disorders

Dupuytren contracture is diagnosed by examining the hand; imaging and other tests are rarely needed. The clinician feels the nodules and cords and measures how far each finger joint can straighten. A simple check is whether you can place your palm and fingers flat on a table. Repeating the measurements at later visits shows whether the condition is progressing.

There is no cure, and no treatment stops the underlying condition. Many people with nodules or mild bending need only observation. Treatment is generally considered when a finger bends far enough to interfere with daily activities or when the hand can no longer lie flat. Stretching and splinting on their own do not reverse a contracture, and forceful stretching can injure the finger.

Office-based options:

• A corticosteroid injection, which may ease a tender nodule but does not straighten a bent finger
• Needle aponeurotomy: a needle is passed through the skin to divide the cord, usually in the office with local anesthesia
• Collagenase injection: an enzyme is injected into the cord to weaken it, and the finger is straightened at a follow-up visit to break the cord

Surgery: in a fasciectomy, the surgeon removes the thickened tissue through incisions in the palm and finger. It is often used for more advanced contractures or when several joints are involved, and recovery is usually longer than after office-based procedures. A skin graft is occasionally needed.

The choice among these options depends on which joints are involved, how severe the bending is, any earlier treatment, and your preferences. Contractures can return after any treatment, and the condition can also appear in new areas of the hand.

After needle aponeurotomy or collagenase treatment, a night splint and finger exercises are commonly recommended for a period, and recovery time is usually shorter than after surgery. After fasciectomy, wound care, a splint, and hand therapy are usually needed for several weeks to regain motion. Swelling and stiffness are common early on, and keeping the hand raised helps.