Dupuytren’s contracture: Causes, treatment options, and when to consider surgery

Dupuytren’s contracture is a hand condition that affects the connective tissue beneath the skin of the palm and fingers. Over time, this tissue thickens and tightens, causing the fingers—most commonly the ring and little fingers—to curl inward. The condition progresses slowly and can impact hand function, making everyday tasks difficult.

The exact cause of Dupuytren’s contracture is not fully understood, but genetics play a major role. It is more common in men over 50, particularly those of Northern European descent. Risk factors include a family history of the condition, smoking, excessive alcohol consumption, and certain medical conditions like diabetes and epilepsy.

Treatment for Dupuytren’s contracture depends on the severity of the condition. In mild cases where hand function is not significantly affected, observation and regular monitoring may be sufficient. Stretching and hand therapy do not typically stop progression but may help maintain flexibility.

Non-surgical options include enzyme injections such as collagenase clostridium histolyticum (Xiaflex), which dissolves the thickened tissue, allowing the finger to straighten. Needle aponeurotomy is another minimally invasive procedure where a needle is used to break the tight cords of tissue.

Surgery is considered when the condition limits hand use or causes significant finger deformity. A fasciectomy, where the thickened tissue is removed, is the most common surgical approach. In severe cases, a skin graft or joint fusion may be required. While surgery can restore hand function, recovery involves physical therapy and carries risks such as nerve damage and recurrence.

Early diagnosis and consultation with a hand specialist are key to managing Dupuytren’s contracture effectively. Understanding the condition and exploring treatment options early on can help preserve hand function and improve quality of life.