Dupuytren’s contracture is a condition in which fibrous tissue grows in the palm of the hand and attaches to the tendon sheaths, pulling the fingers in toward the middle of the hand.

The layer of tissue that lies beneath the skin in the fingers and the palms of the hands is called the fascia. As the fascia thickens and tightens, the fingers bend toward the palm, and it becomes impossible to extend them fully.

The fibrous tissue can create thickened cords in the palm. The condition usually affects the fourth and fifth fingers, known as the ring finger and the little finger or pinky. However, the thickening can extend into any of the digits, including the thumb.

Other names for Dupuytren’s contracture are Morbus Dupuytren, Dupuytren’s disease, and palmar fibromatosis.

There is no permanent cure for Dupuytren’s contracture, so treatment will focus on improving a person’s ability to extend the affected hand and digits.

In many cases, the contracture is mild and does not stop a person from doing everyday tasks.

Since the symptoms are typically not serious, treatment is not a necessity. A person can decide whether they want treatment or not based on their level of discomfort and how it affects their daily life.

The available treatments include:

Steroid injections

Injecting corticosteroids into a nodule may relieve pain and inflammation and may help slow the progression of the condition.

Collagenase injections

Collagenase clostridium histolyticum (CCH) injections are a relatively new type of treatment.

The Food and Drug Administration (FDA) approved CCH for Dupuytren’s contracture in 2010 under the brand name Xiaflex.

For this treatment, a doctor will inject the enzyme collagenase into the cords to weaken them. Next, they will pull and break the cords, allowing the fingers to straighten so that the person can use them again.

A 2016 study of 213 people who had received CCH treatment found that 73% were very satisfied or satisfied with the results, and 21% were dissatisfied. Out of the 78 participants who previously had surgery, 71% said that they preferred CCH to surgery.

In the long term, this treatment may not be as effective. Research shows that the recurrence rate for the condition 5 years after treatment is at least 66%.

Surgery

A doctor may recommend surgery to remove or loosen the cords in cases where the condition is limiting a person’s use of the hand or where tissue wrapped around arteries and nerves is raising the risk of injury.

In some cases, surgeons can perform the procedure using local anesthesia. However, they usually use regional or general anesthesia. Either way, the operation is typically an outpatient procedure, meaning that the individual will not need to stay in the hospital overnight.

According to the American Academy of Orthopaedic Surgeons, the two most common surgical procedures for Dupuytren’s contracture are:

Fasciotomy

The surgeon cuts the connective tissue to relieve the tension. They may push a fine needle with a sharp bevel into the skin and over the contracture to use as a knife.

The surgeon will cut or divide the thickened tissue under the skin. However, they will not remove it.

The doctor will leave the wound open, and the person may need to use a splint while the wound heals.

Subtotal palmar fasciectomy

The surgeon will remove the connective tissue entirely. They may need to make several incisions, which they will often do in a zigzag pattern.

Occasionally, a person may need a skin graft to help the wound heal.

Physical and occupational therapy

After surgery, a combination of physical and occupational therapy can help a person regain the function of their hand.

Researchers do not yet know precisely what causes Dupuytren’s contracture. However, they believe that genetic factors play a role.

Studies have found that the condition commonly affects people from Northern Europe.

Other possible risk factors include:

  • alcohol consumption
  • older age
  • specific genes, as it seems to run in families
  • diabetes, especially type 1
  • smoking
  • vascular diseases

People with diabetes and those taking medication for epilepsy also appear to have a higher risk.

A person with Dupuytren’s contracture may benefit from the following exercises:

Finger lifts

  1. Place the affected hand flat on a table.
  2. Raise each finger once and hold for a few seconds.
  3. Repeat several times daily.

Tendon glides

  1. Start with the hand straight and pointing up.
  2. Bend the top 2 joints of all the fingers while keeping the knuckles straight.
  3. Then make a fist.
  4. Open your hand back to straight and bend to make another fist.
  5. Repeat about 10 times.

Finger spreads

  1. Place your hand flat on a table.
  2. Spread your fingers wide and draw them back in together.
  3. Repeat multiple times.

A contracture is an abnormal shortening of tissue that affects the range of motion. Dupuytren’s contracture is a shortening of the palmar fascia. This is the thin, tough layer of fibrous tissue that lies between the skin of the palm and the underlying tendons, which allow people to flex their fingers.

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Dupuytren’s contracture is an abnormal thickening of the skin at the base of the fingers. PeterTG/Getty Images

The symptoms of this condition develop gradually over several years. The first sign is often a tender lump in the palm. There may be some pain at first. However, this usually goes away.

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Dupuytren’s contracture is a condition that causes the fingers to contract over time. Frank C. Müller, CC BY-SA 4.0, via Wikimedia Commons

Tough bands of tissue may develop, and it will become harder for the individual to stretch out their hand. Although the bands may resemble cords or tendons, the condition does not involve the tendons.

Unusual dimples or lumps may appear in the palm, and the skin may pucker over these.

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The cause of Dupuytren’s contracture is the development of thickened tissue at the base of the fingers. This causes bending of the fingers. James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons

The contracture will usually pull one or more of the fingers in toward the palm and make it impossible for the person to extend them.

Dupuytren’s contracture can affect one or both of the hands. Less commonly, it may affect the toes, known as Ledderhose disease, or the penis, called Peyronie’s disease.

The condition is not usually painful. However, it makes it harder to use the fingers. The symptoms can range from mild to severe.

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Dupuytren’s contracture develops slowly over time and can cause disability of the hands. Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons

Trigger finger happens when a person is not able to straighten or bend their finger. It typically occurs in the ring finger or the thumb. However, it could affect any finger.

It tends to occur due to overuse of the finger or contact friction. It may also be related to diabetes, as well as rheumatoid arthritis.

Though trigger finger appears to be similar to Dupuytren’s contraction, the conditions have different causes. Trigger finger occurs due to a trapped flexor tendon in the hand. Dupuytren’s contracture results from the thickening of the palmar fascia.

Though they are different conditions, a subset of people may experience both problems.

To diagnose Dupuytren’s contracture, a doctor will check the hands for dimples, pitted marks, thickened skin, bent fingers, and lumps, or nodules.

They may ask the person to do a “tabletop test,” which requires them to place their hand flat on the surface of a table with the palm facing down.

If the person cannot flatten their hand, it is likely that they have the condition.

Dupuytren’s contracture happens when tissue thickens and tightens under the palm, pulling at least one finger in toward the middle of the hand.

The causes are likely to be genetic, and the condition usually progresses slowly over time. Most people do not need treatment. However, surgery and other options are available for those who do.