All about Dupuytren’s contracture

Dupuytren’s contracture is a condition affecting the connective tissue in the palm of the hand. It causes the fingers, most commonly the ring and little fingers, to gradually bend towards the palm. Although it is usually painless, the progressive loss of hand function can interfere with everyday activities such as shaking hands, wearing gloves or putting a hand into a pocket.

What causes Dupuytren’s contracture?

The condition occurs when the layer of tissue beneath the skin of the palm (the palmar fascia) thickens and shortens. Over time, this pulls the fingers into a bent position. The exact cause is unknown, but factors that may contribute include:

Genetics: It often runs in families, especially of Northern European descent.
Age and sex: It is more common in men over 50.
Lifestyle factors: Smoking and heavy alcohol use may increase risk.
Medical conditions: It may be associated with diabetes or epilepsy.

What are the symptoms?

Dupuytren’s contracture usually develops slowly and may start with a firm lump or nodule in the palm. As the tissue thickens and tightens, it forms cords that pull the fingers down. The condition does not typically cause pain, but it can reduce grip and hand function over time.

How is it treated?

Treatment depends on how much the contracture affects daily life. Early cases without significant finger bending may simply be monitored. When intervention is needed, options include:

Needle aponeurotomy: A needle is used to divide the tight cords in the palm. This is a minimally invasive outpatient procedure with a quick recovery.
Collagenase injections: An enzyme is injected to weaken the cords, which are then manipulated to straighten the fingers. However, this treatment is currently not available in the UK any longer, as the license has been withdrawn.
Limited fasciectomy: Surgery to remove the affected tissue. This is usually recommended for more severe contractures and offers a longer-lasting result.
Dermofasciectomy: Both the diseased tissue and the overlying skin are removed, and a skin graft is used. This is considered for recurrent or aggressive disease.

What does recovery involve?

Following any procedure, hand therapy is often required to restore movement and strength. Splints may be used at night to maintain finger extension. Recovery times vary, with minimally invasive treatments allowing return to normal activities within days, while open surgery may require several weeks of rehabilitation.

When should you see a doctor?

If you notice lumps in your palm or your fingers are starting to bend, it is important to seek medical advice early. Treating the condition before it becomes severe can lead to better outcomes and reduce the need for more extensive surgery.

Is Dupuytren’s contracture likely to return?

Recurrence of Dupuytren’s contracture is possible with all treatments, though open surgery usually provides the most durable result. Regular follow-up with a hand specialist helps to monitor any changes and manage the condition effectively.

Modern techniques mean that many patients can have their hand function restored with minimal discomfort and downtime.