Ask the expert: what is Dupuytren's contracture? 

Dupuytren's contracture, pronounced du-pwe-trenz contracture, refers to thickening of the tissue underneath the skin of the palm and/or fingers. Over time it can become difficult to straighten the affected finger(s). 

Dupuytren’s contracture most commonly affects the little finger and ring finger, although in more aggressive cases, it can affect the index and middle fingers. 

How does Dupuytren’s contracture develop?

Underneath the skin of your hand is a layer of connective tissue called fascia. It is this tissue that thickens during Duytren’s contracture. It starts with cells of the fascia dividing and growing to form small nodules. 

Eventually, these nodules coalesce into a cord. Over time, the cord thickens and shortens, which is what causes your affected finger to be pulled in towards your palm — this is called a contracture. 

If you develop Dupuytren’s contracture in one hand, there is a high risk that you will eventually develop it in your other hand. 

Signs and symptoms of Dupuytren’s contracture

Dupuytren’s contracture is generally painless; however, you may experience painful and/or tender nodules in the early stages. 

As your Dupuytren’s contracture worsens, you may find it difficult to use your hand properly. A common test for the severity of Dupuytren’s contracture is the tabletop test where you try to lay your hand, palm down, flat on a table — Dupuytren’s contracture can make it difficult to completely flatten your fingers on the table. 

Day-to-day challenges may include finding it difficult to pick something up from your pocket, accidentally poking yourself in the eye with a bent finger when washing your face, and struggling to put on and/or wear gloves. 

In some cases, Dupuytren’s contracture can affect the feet. This leads to plantar fibromatosis, that is, growths in the arch of your affected foot that can be painful when wearing shoes or walking. 

Risk factors for Dupuytren’s contracture

Although the cause of Dupuytren’s contracture is unknown, there are several known risk factors, including age, gender and ethnicity. 

Dupuytren’s contracture is more common in those over the age of 50 and is up to six times more common in men than women. Your risk is slightly higher if you’re of European descent and also if you have a family history of the condition. However, if you have a parent with Dupuytren’s contracture, this does not mean you will definitely develop the condition yourself — Dupuytren’s contracture can skip generations. 

Your risk of Dupuytren’s contracture is also higher if you work in a profession where you regularly use vibrating tools. The reason behind this association isn’t yet clear as vibration itself doesn’t cause Dupuytren’s contracture. 

There is also an association between smoking and Dupuytren’s contracture. It is, therefore, advised that you quit smoking if you have Dupuytren’s contracture or are worried you may develop it.  

Conditions associated with Dupuytren's contracture

If you have Dupuytren’s contracture, you have a slightly higher than average risk of developing trigger finger (stenosing tenosynovitis).

You’re also at a slightly higher risk of developing carpal tunnel syndrome and lumps on your ring, index or middle fingers called ganglions — Dupuytren’s contracture is not thought to be directly responsible for causing these conditions but there is nonetheless an association. 

Getting a diagnosis

Dupuytren’s contracture is diagnosed through a physical examination of your hand and asking about your symptoms and medical history.

Although imaging tests are not routinely needed, if the thickened cord that causes Dupuytren’s contracture can’t be felt, but your finger is nonetheless curled down, your doctor may recommend an ultrasound scan to rule out other causes of your bent finger. 

Treating Dupuytren’s contracture

Treatment options for Dupuytren’s contracture vary in their invasiveness, and which treatment you have will depend on the stage of your condition, which fingers are affected, your age and whether you have previously had surgery to treat your condition. 

Deciding when to get treatment will depend on how much the condition is affecting your quality of life. If you feel that it is having a significant impact on your ability to perform daily tasks, your surgeon will recommend treatment. 

Treatment can cure Dupuytren’s contracture, but it doesn’t prevent it from returning. The younger you are when you have treatment, the more opportunity there is for Dupuytren’s contracture to return in the future. 

Procedures to treat Dupuytren’s contracture are all usually performed as day case  procedures, which means you can return home on the same day as your procedure. 

Percutaneous needle fasciotomy

The least invasive treatment for Dupuytren’s contracture is a percutaneous needle fasciotomy (PNF) where the thickened cord is broken, either in your palm or in your finger, to help release your curled finger. 

The recurrence rate of Dupuytren’s contracture after PNF is around one in five. 

Segmental fasciectomy and total fasciectomy

Segmental fasciectomy and total fasciectomy are more invasive than PNF. Your procedure may be performed under regional anaesthesia (an axillary block) or general anaesthesia.

A fasciectomy aims to straighten your bent finger by removing parts (segmental fasciectomy) or all (total fasciectomy) of the thickened cord in your hand. 

Dermofasciectomy

The most invasive treatment for Dupuytren’s contracture is a dermofasciectomy with a full thickness skin graft. It is performed under general anaesthesia.

This involves removing all of the thickened cord as well as all of the skin that is affected by Dupuytren’s contracture. The skin is replaced with skin from another part of your body, usually the inner side of your forearm.

The recurrence rate of Dupuytren’s contracture after this procedure is around one in 20.

Living with Dupuytren’s contracture

In the early stages of Dupuytren’s contracture, you can ease your discomfort through massaging the nodules to help soften them. If you see a cord growing along your palm into your finger, you can start performing gentle, passive stretches where you use your other hand to move your affected finger. 

As your condition progresses, you may find assistive devices useful to help with daily activities, such as easy-grip kitchen utensils and gloves with padded palms to help ease discomfort when gripping items.