Dupuytren Contracture

Dupuytren contracture thickens and tightens tissue under the skin of your palms and fingers, which can make your fingers curl in toward your palm. It’s also known as Dupuytren disease or Viking’s disease.

Small bumps called nodules grow on the fascia in your hand. Fascia is the net-like tissue under your skin that supports your hand and fingers. Eventually, the nodules might form thick cords under your skin and bend your fingers so much that you can’t straighten them.

The growths that cause Dupuytren disease are always benign. This means they’re never a symptom or sign of cancer. You might need surgery. But more conservative treatments can manage many cases.

Symptoms of Dupuytren contracture

If you have mild symptoms, you may never even know you have Dupuytren contracture. It can take months (or even years) to develop. It most commonly happens to your ring and pinkie fingers. But it can affect any of your fingers, including your thumb.

Symptoms develop and progress in stages:

• Nodules: These are small bumps under the skin on your hands. They usually form at the base of your fingers, where they meet your palm. Eventually, you might be able to feel or see them. The nodules can make your skin around them look dimpled or puckered. They sometimes go away on their own. But they may progress to cords.
• Cords: Over time, the nodules may thicken into long cords of tissue on your normal fascia. The cords can pull on your fingers. This may make it feel like they’re constantly being tugged toward your palm.
• Contracture: The most advanced symptom is what gives Dupuytren contracture its name. The cords can grow so thick and tight that you can’t extend or straighten your affected fingers away from your palm.

Other symptoms are rare, but can include:

• Swelling
• Tenderness or pain, like having a callous
• A feeling of burning or itching

Dupuytren contracture causes

Experts aren’t sure what causes Dupuytren disease. Healthcare providers consider it a genetic disorder. That’s because you’re much more likely to develop it if one of your biological family members has had it.

Risk factors of Dupuytren disease

Dupuytren contracture can affect anyone. You may have a higher risk if you:

• Are male
• Are of European descent
• Have a family history

Having certain health conditions can increase your risk, including:

• Diabetes
• Epilepsy and other seizure disorders
• Alcohol use disorder
• HIV and AIDS
• Vascular disease

Complications of this condition

Dupuytren disease treatment complications are rare. But they can include:

• Nerve damage
• Infection
• Scarring
• Damaged blood vessels
• Wound healing problems

How doctors diagnose this condition

A healthcare provider will diagnose Dupuytren contracture by looking at your hand and fingers. They’ll feel for nodules and cords under your skin. Your provider will measure the contracture if you have trouble straightening your fingers.

Your provider may suggest blood tests or an X-ray if they think you might have another condition that causes similar symptoms.

Dupuytren disease treatments

Which treatments you need will depend on how severe the symptoms are. If you only have mild symptoms, you might need:

• Physical therapy (PT): PT or stretching exercises can help your fingers regain their usual range of movement.
• Wearing a brace or splint: These will hold your fingers in the correct position and keep your fascia stretched. This can counteract the extra tightness.
• Ultrasonic or heat treatments: This is using painless sound or heat waves to increase your fascia’s flexibility.
• Corticosteroid injections: These medications can shrink nodules or cords.

It might take months or years for you to need the next level of treatment. That’s because Dupuytren contracture develops so slowly. But if you develop more severe symptoms, you may need:

• Radiation therapy: This uses X-rays or other beams to soften and destroy nodules or cords.
• Needle aponeurotomy (percutaneous fasciotomy): Your healthcare provider will poke holes in the cords and extra tissue with a needle to release tension and break it up.
• Collagenase injections: This is an enzyme that breaks down the cords. Your provider will inject it into the cords. Then, they’ll stretch your fingers back to their usual positions.
• Surgery: You might if symptoms make it hard or impossible to use your hand. A surgeon will remove some or all of the diseased fascia with a fasciectomy.

When should I see my healthcare provider?

Visit a healthcare provider if you think you have any Dupuytren contracture symptoms.

See your provider if it feels like the symptoms are getting worse. Or if they come back after you’ve started treatment.

The tabletop test is a good way to monitor symptom changes. Place your hand palm side down on a flat surface like a table. If any of your fingers aren’t lying flat, there’s a good chance the symptoms are progressing. Let your provider know as soon as possible.

What can I expect if I have Dupuytren disease?

Follow the instructions your provider gives you. Dupuytren contracture treatments take months. It’s important to do your stretches or physical therapy exercises as best you can, as often as you need to.

Following your therapy guidelines is especially important if you’ve had surgery. Some studies show that up to half of surgery’s benefits come from stretching and physical therapy after the operation itself.

You might have symptoms again in the future, even if you get better. If you have Dupuytren disease symptoms once, there’s a good chance the nodules or cords will grow back. Don’t be discouraged. But let your healthcare provider know right away if you notice symptoms again. The sooner you get treatment, the more likely it is you can manage symptoms before they advance.