Dupuytren’s Contracture

What it is

Overview

Dupuytren’s contracture is a common hand condition where the tissue under the skin of the palm thickens and tightens over time. This forms lumps (nodules) and thick bands (cords) that pull one or more fingers toward the palm, making it hard or impossible to straighten them. It usually affects the ring and little fingers first and can involve both hands. The condition develops slowly, often over years, and isn’t typically painful, though early lumps may be tender.

Common signs and symptoms include:

Small, firm lumps or pits in the palm.
Puckering or dimpling of the skin.
Thick cords under the skin that extend to the fingers.
Bent fingers that won’t fully extend, affecting tasks like grasping objects, shaking hands, or putting on gloves.
In advanced cases, fixed bending that limits hand function

It affects about 5% of people, mostly men over 50, and while not cancerous, it can worsen gradually

When to see specialist

Causes & risk factor

The main cause is genetics—it’s often inherited and runs in families, with higher risk in people of Northern European or Japanese descent. The condition involves abnormal changes in the hand’s connective tissue, leading to excessive collagen buildup.

COMMON RISK FACTOR

Age (most common after 50) and being male.
Diabetes, which increases risk.
Smoking and heavy alcohol use, which can worsen tendon and tissue health.
Trauma or overuse, such as from jobs with vibrating tools or repetitive hand strain.
Certain medications or conditions like epilepsy.

Treatment Options

Treatment depends on severity; mild cases may just need monitoring. There’s no cure, and recurrence is common with all options.

non-surgical

First-line Option Treatment

Observation and hand exercises if symptoms are minimal.
Steroid injections to soften early nodules and reduce pain.
Needle aponeurotomy: A needle breaks the cords in an office procedure.
Collagenase injections (like Xiaflex): An enzyme dissolves the cords, followed by stretching. Unfortunately this is not covered by PBS.

Success rate

These are less invasive with quicker recovery and succeed in about 50-75% of cases initially, though recurrence often happens within 3-5 years, and there is risk of nerve injury with needle aponeurotomy.

surgical

Fasciectomy

This is a surgical removal of diseased tissue through an incision. Skin grafts may be required for the surgery.