Dupuytren’s contracture – what is it?

Dupuytren’s contracture (also known as Dupuytren contracture) is a condition that can affect the hands, causing fingers to bend in towards the palms. Find out the causes and treatment.

What are the symptoms?

What causes it? 

When to see a doctor

Getting diagnosed

Treating Dupuytren’s contracture

This condition means that 1 or more fingers bend towards the palm of your hand, so you can’t straighten them properly. It can range from mild to severe and usually develops slowly, in some cases over years. If it progresses and becomes severe, there are steps you can take to help you regain your hand function. 

This condition affects the connective tissue in the hand. 

Affecting around 5% of people, Dupuytren's (also known Dupuytren) contracture starts when the fascia – the stretchy tissue under the skin on your palm – forms lumps. Eventually, the lumps may thicken into long cords of tissue and start to pull 1 or more fingers inwards towards your palm, in a bent position. That’s the contracture that gives the condition its name.

This condition is usually painless, and for some people, the symptoms are so mild they don’t get in the way of daily life.

If Dupuytren’s contracture is more severe, you may find it hard to do anything that requires gripping, or having a flat hand or flexible fingers, like putting your hand in a pocket, wearing gloves, typing, playing sport, or shaking hands. 

## What are the symptoms?

Dupuytren’s contracture may start slowly, with different symptoms sometimes appearing over time, such as:

- a small, firm lump nodule in your palm – this is usually the first sign
- the skin on 1 area of your palm starts to thicken. It may look puffy in places, and puckered in others
- the thickened tissue can eventually form into tight cords that reach from your palm into your fingers, pulling them inwards
- the affected fingers may start to bend inwards, meaning you can no longer straighten them, or open your palm out flat
- your hand function may be affected, and everyday activities – even simple things, like washing your hands or putting on gloves – can become challenging.

The condition can affect any of your fingers, or your thumb. It most commonly impacts the 2 fingers furthest from your thumb – your ring finger and pinkie – and you may have it in both hands.

Severity can vary too. If you’re only mildly affected, you may still be able to straighten your fingers, grip things, and open your palm. In fact, you may never even know you have the condition. Dupuytren's contracture may never progress beyond this mild stage, or it may eventually start to get worse. But that can take years.

Get help with this

## What causes it? 

Doctors don’t know exactly what causes Dupuytren’s contracture, but it’s sometimes considered a genetic disorder because you’re much more likely to develop it if you have an affected family member. 

If you have several relatives with Dupuytren’s contracture, you may be at risk of more severe symptoms. Men are also more likely to experience more serious symptoms.

You may also be at higher risk if you:

- drink lots of alcohol
- smoke tobacco
- have [diabetes](https://www.livehealthily.com/health-library/conditions/diabetes) or epilepsy. 

## When to see a doctor

See a doctor if you think you have Dupuytren’s contracture because 1 or more of your fingers are bent, you’re unable to place your hand down flat, and you’re having trouble trying to carry out everyday tasks with your affected hand(s).

## Getting diagnosed

Your doctor can confirm the diagnosis by simply looking at your hands, and assess whether or not treatment will be helpful. They may recommend monitoring and following up, if your symptoms come back or get worse. 

As Dupuytren's contracture progresses, it can be harder to treat, so don’t delay seeing your doctor, if you think it might be getting worse. The tabletop test can be a good way to check. Place your palm down on a flat surface – if the affected fingers don’t lie flat, the condition may be progressing.

Always see a doctor if you have any pain, burning, itching, swelling, or tenderness in the affected hand – 1 in 4 people with Dupuytren’s contracture will have these symptoms and they may be a sign of other issues that can affect the skin or connective tissue.

## Treating Dupuytren’s contracture

Your doctor may recommend treatment to manage the condition, if it’s affecting your daily life – they can offer different options at various stages. 

If treatment helps at an early stage, you may not need anything else. But there’s no cure for Dupuytren’s contracture, and symptoms may come back, so you might need more treatment in future.

In the earlier stages, your healthcare provider may suggest:

- __exercises__ or physical therapy
- __wearing a brace__ or splint on the affected hand to stretch your fingers 
- __ultrasonic or heat treatments__ to make the fascia (tissue under the skin) more flexible
- __corticosteroid injections__ to shrink the nodules and cords.

With these treatments, it may be a few months before you notice an improvement.

If symptoms don’t get better, the next steps may include:

- a procedure called a needle aponeurotomy (also known as a percutaneous needle fasciotomy), where your healthcare professional makes tiny holes in your fascia to help release tension so your fingers can straighten
- injections of an enzyme called collagenase, which can help to break down the growths on your fascia.

If Dupuytren’s contracture is more severe, you may need surgery to cut or remove the affected fascia. There are a few different ways of doing this, and your doctor will explain the options. After surgery: 

- it can take up to 2 months to notice a full improvement 
- your surgeon may fit a splint to wear at night, and suggest physical therapy to strengthen the joints in your hands after the surgery 
- Dupuytren’s contracture can come back, but most people who have surgery only need to do this once.

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References

Charlotte Haigh

Fiona Bugler

Dr Emily Blount

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