Dupuytren’s Disease (Dupuytren’s Contracture)

What Is Dupuytren’s Disease?
Dupuytren’s disease is a chronic condition that affects the connective tissue in the hand. Over time, this tissue thickens and tightens, forming hard cords beneath the skin of the palm called Dupuytren’s contracture. These cords can pull one or more fingers into a bent position, making it hard to straighten them.

While the disease is not usually painful, it can significantly limit hand function, making everyday tasks like shaking hands, typing or putting your hand in a pocket more difficult.

Despite common confusion, Dupuytren’s contracture is not the same as trigger finger. In trigger finger, a tendon in the finger gets stuck, causing a painful clicking sensation. In Dupuytren’s, the fascia (a layer of tissue under the skin), and the finger stays bent without snapping.

What Leads to Dupuytren’s Disease?
Hand and wrist specialists aren’t exactly sure what causes Dupuytren’s disease, but several factors are believed to contribute.

Risk factors include:

• Genetics: There is often a family history of the disease
• Age: Most common in people over 40, especially men.
• Gender: Men are more likely to be diagnosed and often have more severe symptoms than women.
• Northern European descent: It's most prevalent among people with ancestry from Scandinavia, Ireland and other northern regions of Europe.
• Smoking and alcohol: These may increase the risk or speed up progression.
• Chronic illnesses: People with diabetes, seizure disorders or autoimmune conditions may be more likely to develop Dupuytren’s.
  
  

Unlike some other hand conditions, Dupuytren’s disease is not caused by overuse, injury, or repetitive movements.

What Does Dupuytren’s Disease Feel Like?
Dupuytren’s disease usually develops slowly over months or years and may affect one or both hands. Symptoms often begin in the palm and gradually spread toward the fingers.

Common signs include:

• A small, painless lump or nodule under the skin in the palm that often feels firm and rubbery
• Thickened or dimpled skin near the base of the fingers
• Visible cords under the skin, especially when fingers start to pull inward
• Gradual curling of one or more fingers, most commonly occurring in the ring and little fingers
• Difficulty placing the hand flat on a surface – also referred to as the “tabletop test”
• Discomfort when wearing gloves, shaking hands or holding large objects
  
  

As the disease progresses, the affected fingers may become permanently bent. Once contractures develop, normal hand function becomes more limited.

How Is It Diagnosed?
A hand and wrist specialist or orthopedic provider typically diagnoses Dupuytren’s disease during a physical exam. Imaging is not usually needed unless other hand issues are suspected.

A typical exam includes:

• Checking for nodules, cords, and tightness in the palm
• Performing the tabletop test (asking you to lay your palm flat on a table)
• Measuring finger flexion and range of motion
• Asking about daily function: Is it hard to put on gloves? Grip a steering wheel? Wash your hands?
  
  

Early diagnosis allows for better monitoring and earlier intervention if needed.

What Are Some Common Treatment Options for Dupuytren’s?
There is no known cure for Dupuytren’s disease, but treatment can help improve hand function and prevent further contracture. Treatment depends on how much the condition interferes with daily life.

Non-surgical options include:

• Observation and monitoring – especially if you don’t have a contracture yet
• Stretching and hand therapy – to maintain motion in early stages
• Needle aponeurotomy – a minimally invasive procedure where a needle is used to break up the thick cords
• Collagenase injection (Xiaflex®) – an enzyme injection that weakens and dissolves the cords, allowing the finger to straighten with gentle manipulation
  
  

Surgical treatment may be needed when the contracture significantly limits hand function, the finger cannot straighten enough to perform daily tasks or when non-surgical treatments are no longer effective.

Surgical options include:

• Limited fasciectomy – removes the thickened cords through small incisions
• Dermofasciectomy – removes both diseased tissue and skin, followed by skin grafting
• Recovery typically involves splinting, physical therapy and a few weeks off from heavy use.

Can You Avoid Dupuytren’s?
Because genetics play a major role, you can’t fully prevent Dupuytren’s disease, but you can catch it early and slow its progression with healthy habits.

Helpful tips:

• Watch for early signs – like a lump in your palm or finger stiffness
• Stretch your hands daily – especially if you have a family history
• Maintain overall health – keep blood sugar levels and inflammation under control
• Avoid smoking and limit alcohol, which may contribute to tissue changes
  
  

If you notice changes in your palm, don’t ignore them. Early care can help preserve movement and delay the need for surgery.

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