Dupuytren's Contracture

Dupuytren's contracture is a thickening of the fascia, the connective tissue layer just beneath the skin of the palm. Over time this tissue can form firm nodules and cords that gradually pull one or more fingers, most often the ring and little fingers, into a bent position at the base knuckle.

It is a slowly progressive condition, often developing over years, and the rate and severity of progression vary considerably between individuals. Not everyone with early nodules goes on to develop a significant contracture.

The exact cause of Dupuytren's contracture is not fully understood, though it has a strong genetic component; it is significantly more common in people of Northern European ancestry and often runs in families. Age and male sex increase the likelihood of developing it, and smoking, diabetes and heavier alcohol use are recognised associated factors.

It is not caused by hand injury or manual work, a common misconception, though these factors do not appear to meaningfully influence its development or progression.

Typical features of Dupuytren's contracture include:

• Firm lumps or nodules in the palm, which are often painless
• Thickened cords running from the palm into one or more fingers
• Gradual bending of the affected finger or fingers toward the palm
• Difficulty placing the hand flat on a surface, or fitting the hand into a glove
• In more advanced cases, difficulty with tasks such as shaking hands or reaching into a pocket

Progression is usually slow, over months to years, though the pace varies between individuals.

Treatment is guided by how much the contracture is affecting hand function rather than the presence of nodules alone. Mild cases with no significant finger bending are usually simply monitored.

Where a finger has developed a meaningful contracture, options include needle aponeurotomy, a minimally invasive procedure that divides the tight cord through a needle, and collagenase injection, which uses an enzyme to soften and break down the cord, both performed without an open surgical incision.

For more significant or recurrent contractures, surgical release of the affected tissue, known as fasciectomy, may be recommended, allowing more thorough correction of the finger position.

Dupuytren's contracture cannot be cured, and recurrence after treatment, whether by injection-based procedures or surgery, is a recognised part of the natural history of the condition rather than a sign that treatment has failed. That said, treatment is generally effective at improving hand position and function for a meaningful period.

Early, mild nodules without significant finger bending often need no treatment at all beyond monitoring.

Dupuytren's contracture is a common, gradually progressive condition affecting the connective tissue of the palm. Treatment is tailored to how much it affects hand function, ranging from simple observation through to injection-based procedures or surgery. If cords or contracture are starting to affect your ability to place your hand flat or grip normally, an assessment can clarify the best option.