Dupuytren's Contracture

Dupuytren's contracture is a condition in which the fibrous tissue layer beneath the skin of the palm gradually develops firm lumps and then thick rope-like cords that shorten and pull one or more fingers into a bent position. The ring and little fingers are most often affected. The process is slow, usually painless, and unfolds over months to years. The problem is functional: as the finger curls, the hand can no longer lie flat and a full grip becomes difficult. The contracture cannot be fully reversed, but treatment can release the cord and let the finger straighten, though recurrence over time is possible.

Common symptoms include:

• A firm, painless lump in the palm near the base of the ring or little finger
• A thick cord under the skin running from the palm toward the finger
• A finger that gradually draws into a bent position and cannot be straightened
• A hand that can no longer lie flat on a table
• Trouble wearing gloves, washing the face, or reaching into pockets

The diagnosis is made by examining the hand. Nodules and cords are easy to feel and see in the palm. Your provider checks how far each affected finger can be straightened and how flat the palm can be pressed against a surface. No imaging is needed for the diagnosis. The degree of bend at the middle knuckle of the finger (the PIP joint) matters most for planning treatment.

When the contracture is mild and not affecting daily activities, it is reasonable to watch and wait. When it begins to limit hand use, two in-office options can release the finger without an incision:

• A collagenase injection, an enzyme placed into the cord to weaken it so the provider can break it the next day
• A needle aponeurotomy, in which a needle is passed through the skin to weaken and sever the cord

Surgery is considered when the contracture prevents the palm from lying flat or when the middle knuckle of the finger becomes bent, which is harder to correct the longer it has been held that way. The operation removes the diseased cord through an incision in the palm, giving the most complete correction and the lowest chance of recurrence, with a longer recovery that includes hand therapy and night splinting.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Dupuytren's Disease — AAOS OrthoInfo