Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosisFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Frequently Asked Questions
Dupuytren’s contracture(DC)—also called Dupuytren’s disease—is a condition that causes an abnormal thickening of thefascia(the layer of tissue under the skin) in the palm at the base of the fingers. The thickened area will develop as either a hard lump or a thick band of skin.
Over time, the skin’s thickening might cause one or more fingers to contract, pull to the side, or bend toward the palm. The two fingers DC most commonly affects are the ring and pinky fingers. It often affects both hands.Though rare, it might also affect the feet.
This article explains Dupuytren’s contracture, including symptoms, causes, treatment, and more.
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Dupuytren’s Contracture Symptoms
Worldwide prevalence for Dupuytren’s contracture is around 4%, according to a 2019Clinics in Dermatologyreport.DC is sometimes considered a systemic disease because it progresses over time.
Some people with Dupuytren’s might experience a mild condition with only soft tissue changes that do not limit function.Others will experience severe symptoms and actual contracture.
Signs and symptoms of DC will appear in stages.
The earliest of those stages is the nodule phase. Nodules often appear over themetacarpophalangeal(MP) andproximal interphalangeal(PIP) joints.
What Are the Metacarpophalangeal (MP) and Proximal Interphalangeal (PIP) Joints?The MP joint is the large joint connecting the finger to the hand. The PIP joint is the middle joint of the finger.
What Are the Metacarpophalangeal (MP) and Proximal Interphalangeal (PIP) Joints?
The MP joint is the large joint connecting the finger to the hand. The PIP joint is the middle joint of the finger.
Noduleswill appear on the palms of the hands. The lumps may feel tender and sore initially, but the pain will subside.
Some people might also experience pitting and dimpling of the skin near the nodule lumps.The skin will appear as if it has been pulled into the palm.
Phase 2 is the cord stage, in which the nodules start to contract.Nodules cause rugged bands of tissue to develop. The tissue bands will be so inflexible they force the finger to bend or curl toward the wrist.
The next stage is the actual contracture phase, in which the curling and bending worsen, making it difficult to straighten out the fingers. You may struggle to pick up objects, retrieve small items, wear gloves, or even put your hands in your pockets.
Dupuytren’s of the Foot
Some people with DC might also develop Dupuytren’s of the foot, sometimes called Ledderhose disease.It causes nodules on the soles of the feet. It will affect both feet and progress slowly.
Dupuytren’s of the foot has been linked to diabetes, alcohol use disorder, liver disease, epilepsy, and repeated foot trauma.It can cause pain and swelling of the feet and toes, trouble walking, and toe curling.
DC of the foot causes you to change how you walk and puts pressure on other parts of the feet and the ankles. Forced changes to walking and your gait can lead to foot or ankle injuries or other foot and ankle troubles.
The causes of DC are unknown, but the condition tends to run in families and is more common in people assigned male at birth.
Risk factors for DC include:
DC usually takes many years to develop, and some people experience a mild condition that never leads to contracture. Early diagnosis and treatment are crucial to avoiding a hand or foot deformity.
A diagnosis or DC starts with a review of your medical and family histories. The healthcare provider will ask you questions about symptoms and other health conditions you have. They will examine your wrists, hands, and fingers. If you have reported foot symptoms, they will also check your toes and soles.
During the physical exam of your hands and feet, the healthcare provider looks for nodules and areas of thickened skin. They will ask you to place your hands flat on a table to see if you have any trouble doing so or discomfort.
The healthcare provider will also want to see how well you grasp, pinch, and feel with your hands as well as your hand’s range of motion.
For DC of the feet, the healthcare provider will want to see how you walk and if you experience pain or have to adjust your walk because of nodules or pain.
The healthcare provider might also take pictures of your hands and feet so they can record changes over time.
They typically won’t useX-raysor other imaging to diagnose DC because it is not an arthritis condition. The healthcare provider might take X-rays only if they suspect or want to rule out a bone or joint problem.
Ultrasound scans can offer answers about the severity and thickening of the skin but are not necessary for diagnosing the condition.
There is no cure for DC, but treatment can help to resolve symptoms. For some, treatment isn’t necessary, but they will need monitoring to see if the condition worsens.
If the condition causes pain or affects your ability to perform daily activities, your healthcare provider will recommend non-surgical treatment. They might recommend surgery later on if the condition worsens or if a hand deformity is present.
Corticosteroid injectionsmay work to slow down the progression of DC.These injections contain powerful anti-inflammatory medicines that can be injected into a nodule to reduce pain.
Collagenase injectionsare newer, less invasive therapies for treating DC. Research shows these injections offer good results in the short and medium terms.An injection typically involves numbing the hand and injecting the enzyme into a nodule area. The enzyme will break down and dissolve the skin bands, allowing the fingers to straighten.
Radiotherapyhas been encouraged as a treatment in early Dupuytren’s disease, although it’s not used frequently in the United States.Even so, the therapy is available, so if other therapies do not reduce progression, your healthcare provider might have more information.
Splinting is not an option for reducing the progression of DC. According to the American Academy of Orthopaedic Surgeons (AAOS), forceful stretching of the contracted finger could lead to injury of the finger or hand.However, splinting might be used after surgery to protect the surgical site.
Surgical Procedures
If DC affects the function of your hand, your healthcare provider might recommend surgery. The goal of surgery is to reduce the contracture and improve function.
The type of surgery for treating DC will depend on the extent of the contracture. Two standard surgical procedures for DC arefasciotomyand subtotalpalmar fasciectomy.
Fasciotomy: With this procedure, a surgeon makes an incision at the palm.They will then divide the thickened cords of tissue. The procedure uses a local anesthetic, leaving the wound open to heal during recovery and then splinted.
Subtotal palmar fasciectomy: With this procedure, the surgeon will move as much of the abnormal tissue as possible to straighten out the fingers.The wound might be left open to heal, or, depending on how much of the hand was treated, a skin graft might be made, sealing it.
A splint will facilitate recovery. Because this procedure is more extensive than a fasciotomy, recovery might be painful and require more healing time and physical therapy.
DC is a progressive condition and incurable condition, but the treatment of the condition can be successful. It is also unknown if the condition will progress. If it does, surgery can restore the hand’s function and movement.
Recurrence of contracture is possible even after surgery. Fortunately, most recurrences are less severe than initial cases and will not require extensive surgical intervention.
One study reported in 2017 inPLOS Onedefined recurrence as “more than 20 degrees of contracture recurrence in any treated joint at one-year post-treatment.“They also suggest reporting recurrences separately for each affected joint and evaluating alternative treatments.
Summary
Dupuytren’s contracture is a condition in which fibrous tissue growth occurs in the palm, causing the layer of tissue under the skin to thicken. As the skin in the palm thickens, the fingers start to pull in or curl toward the middle part of the hand.
The condition causes nodules and cords to develop, eventually leading to the bending or curling of the fingers. Researchers do not know what causes DC, but they suspect possible risk factors, including genetics and family history, older age, being assigned male at birth, diabetes, alcohol consumption, and smoking.
Treatment for DC usually starts with non-surgical treatments, such as injections, to keep the condition from progressing. Surgery is recommended when DC affects hand function and mobility.
Though surgery can restore hand function, it is possible to experience a recurrence even after surgery. Fortunately, recurrences are less severe than initial cases.
Frequently Asked QuestionsDupuytren’s contracture causes tightening and bending of the fingers due to soft tissue changes in the hands or feet. It does not affect the bones and is not considered an arthritis condition.Learn MoreTypes of Arthritis and Rheumatic DiseasesYour risk for Dupuytren’s contracture is higher if the condition runs in your family. Other risk factors are being assigned male at birth and middle age, especially after age 50. Having diabetes, smoking, or drinking too much alcohol might also increase your risk.Surgery can restore the function of your fingers and hand and remove thickened tissue. However, the condition can recur in a milder form. Speak to your healthcare provider if you experience new symptoms of the condition after your recovery from surgery.Learn More5 Risks of Dupuytren’s Contracture Treatment
Dupuytren’s contracture causes tightening and bending of the fingers due to soft tissue changes in the hands or feet. It does not affect the bones and is not considered an arthritis condition.Learn MoreTypes of Arthritis and Rheumatic Diseases
Dupuytren’s contracture causes tightening and bending of the fingers due to soft tissue changes in the hands or feet. It does not affect the bones and is not considered an arthritis condition.
Learn MoreTypes of Arthritis and Rheumatic Diseases
Your risk for Dupuytren’s contracture is higher if the condition runs in your family. Other risk factors are being assigned male at birth and middle age, especially after age 50. Having diabetes, smoking, or drinking too much alcohol might also increase your risk.
Surgery can restore the function of your fingers and hand and remove thickened tissue. However, the condition can recur in a milder form. Speak to your healthcare provider if you experience new symptoms of the condition after your recovery from surgery.Learn More5 Risks of Dupuytren’s Contracture Treatment
Surgery can restore the function of your fingers and hand and remove thickened tissue. However, the condition can recur in a milder form. Speak to your healthcare provider if you experience new symptoms of the condition after your recovery from surgery.
Learn More5 Risks of Dupuytren’s Contracture Treatment
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Genetic and Rare Diseases Information Center.Ledderhose disease.
MedlinePlus.Dupuytren contracture.
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Samulėnas G, Rimdeika R, Braziulis K, et al.Dupuytren’s contracture: incidence of injury-induced cases and specific clinical expression.Medicina(Kaunas). 2020;56(7):323. doi:10.3390/medicina56070323
Guerini H, Morvan G, Vuillemin V, et al.Ultrasound of wrist and hand masses.Diagnostic and Interventional Imaging. 2015;96(12):1247-1260. doi:10.1016/j.diii.2015.10.007
Sood A, Paik A, Lee E.Dupuytren’s contracture.Eplasty. 2013;13:ic1.
Kadhum M, Smock E, Khan A, Fleming A.Radiotherapy in Dupuytren’s disease: a systematic review of the evidence.J Hand Surg Eur Vol. 2017;42(7):689-692. doi:10.1177/1753193417695996
Kan HJ, Verrijp FW, Hovius SER, et al.Recurrence of Dupuytren’s contracture: a consensus-based definition.PLoS One. 2017;12(5):e0164849. Published 2017 May 15. doi:10.1371/journal.pone.0164849
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