Dupuytren's Contracture
Also known as: Dupuytren's disease, Palmar fibromatosis, Viking disease
Dupuytren's contracture is a condition in which the layer of tissue beneath the skin of the palm (the palmar fascia) gradually thickens and tightens. It begins as small, firm nodules in the palm and over months or years can form cords that pull one or more fingers, most often the ring and little fingers, into a bent position that cannot be straightened. It is usually painless but makes activities such as putting on gloves, washing your face or placing your hand flat on a table difficult. The condition runs strongly in families and is most common in men of northern European descent over 50. Treatment ranges from watchful waiting for mild cases to needle release, enzyme injections or surgery when fingers become significantly bent.
At a Glance
- Common symptoms
- One or more firm lumps or nodules in the palm, usually near the base of the ring or little finger, Thickened, puckered or dimpled skin over the palm, A tough cord of tissue extending from the palm into a finger
- Main treatments
- Observation for nodules and mild contractures that do not interfere with hand function, Needle aponeurotomy, in which a needle is used to divide the cord through the skin, a quick procedure with fast recovery, Collagenase enzyme injection into the cord to weaken it so the finger can be straightened a day or two later (availability varies by country)
- Category
- Musculoskeletal · Common in older men of northern European descent; less common in other populations
- See a doctor if
- A lump in the palm or a finger that is starting to bend and cannot be fully straightened
Symptoms
Causes
- Abnormal thickening and contraction of the palmar fascia by overactive fibroblast cells, the cause of which is not fully understood
- Strong genetic predisposition, with many affected people having a family history
- Possible contributing factors such as diabetes, which increases risk
- Associations with smoking, alcohol excess and certain seizure medications
- Repeated hand trauma or vibration exposure may play a role in some people, though evidence is mixed
Risk Factors
- Being male; men are affected far more often and more severely
- Age over 50
- Northern European or Scandinavian ancestry
- A family history of Dupuytren's
- Diabetes
- Smoking and heavy alcohol use
Diagnosis
- Physical examination of the palm and fingers for nodules, cords and skin changes
- The tabletop test: whether you can place your palm and fingers flat on a table
- Measurement of how far each affected finger joint is bent
- Imaging is rarely needed; ultrasound is occasionally used to assess the cords
Treatment
- Observation for nodules and mild contractures that do not interfere with hand function
- Needle aponeurotomy, in which a needle is used to divide the cord through the skin, a quick procedure with fast recovery
- Collagenase enzyme injection into the cord to weaken it so the finger can be straightened a day or two later (availability varies by country)
- Surgery (fasciectomy) to remove the diseased tissue for severe or recurrent contractures
- Hand therapy and splinting after any procedure to maintain the straightened position
- Supportive: hand stretching and massage may ease stiffness but do not prevent the contracture from progressing
- Supportive: managing diabetes well and stopping smoking
Prevention
- There is no proven way to prevent Dupuytren's contracture
- Stopping smoking and moderating alcohol may reduce risk and severity
- Keep diabetes well controlled
- Monitor nodules and seek treatment before the finger becomes severely bent, when outcomes are better
- Protect the hands from heavy vibration where possible
When to See a Doctor
- A lump in the palm or a finger that is starting to bend and cannot be fully straightened
- You can no longer lay your hand flat on a table
- Difficulty with everyday tasks such as putting your hand in a pocket, washing or wearing gloves
- Rapid progression or involvement of several fingers
- Painful nodules, which can be assessed to rule out other causes
Frequently Asked Questions
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