Dupuytren's Contracture

Dupuytren's contracture is a progressive condition affecting the fascia—the connective tissue layer beneath the palm skin. Over time, this tissue thickens and forms cords that pull one or more fingers into a permanently bent (flexed) position. The ring and small fingers are most commonly affected. While painless in most cases, Dupuytren's can significantly interfere with hand function, making it difficult to grasp objects, shake hands, or place the hand flat on a surface.

According to the American Society for Surgery of the Hand, Dupuytren's disease affects millions of people, particularly those of Northern European descent. At Mountain Spine & Orthopedics, our hand specialists evaluate the progression of your condition and recommend treatment based on functional impact.

Dupuytren's contracture typically develops slowly over years:

• Nodules (firm lumps) forming in the palm, often the first sign
• Pitting or dimpling of the palm skin
• Development of thick cords extending from the palm into the fingers
• Gradual bending of fingers toward the palm (contracture)
• Difficulty straightening affected fingers
• Difficulty with activities requiring a flat hand (typing, wearing gloves, placing hand in pocket)

The condition is usually painless, though nodules may be tender when pressed.

Risk factors for Dupuytren's contracture include:

• Northern European ancestry—especially Scandinavian heritage
• Family history of Dupuytren's disease
• Age over 50 years
• Male sex (more common and severe in men)
• Diabetes mellitus
• Smoking and alcohol use
• Certain medications (anti-seizure drugs)
• Manual labor with vibrating tools

Diagnosis of Dupuytren's contracture is clinical, based on visual inspection and physical examination. Our specialists assess the presence of nodules, cords, and the degree of finger contracture. The "tabletop test" is positive when you cannot place your palm flat on a table surface.

No imaging is typically required for diagnosis, though ultrasound may help differentiate Dupuytren's from other palm masses. We measure finger extension to track progression and determine when intervention may be beneficial.

Non-Surgical Treatment

For early or mild Dupuytren's without significant contracture:

• Observation—many cases progress slowly or stabilize
• Stretching exercises to maintain finger mobility
• Collagenase injections (Xiaflex)—an enzyme that weakens the cord, allowing it to be ruptured manually
• Needle aponeurotomy—using a needle to divide the cord in office

Surgical Options

When contracture significantly affects function:

• Fasciectomy—surgical removal of the thickened tissue
• This provides the most complete treatment but requires longer recovery
• Recurrence is possible with any treatment

Unlike many hand conditions, Dupuytren's contracture is generally not painful. The nodules may be tender to pressure in early stages, but the primary problem is loss of function due to the inability to straighten the fingers. Patients often seek treatment when they can no longer perform activities that require a flat hand or straight fingers.

Prevention Tips

There is no proven way to prevent Dupuytren's contracture, but managing risk factors may help:

• Control diabetes with proper medical management
• Quit smoking and moderate alcohol consumption
• Avoid repetitive gripping with vibrating tools when possible
• Maintain hand flexibility with regular stretching
• Seek evaluation early if you notice palm nodules or finger bending

If you've noticed nodules in your palm or your fingers are bending toward your palm, schedule a consultation with our hand specialists. We offer same-day and next-day appointments at our FL, NJ, NY, & PA locations to evaluate your Dupuytren's contracture and discuss treatment options.