Dupuytren Contracture (Dupuytren Disease)

Also known as: Dupuytren's contracture, Dupuytren's disease, Palmar fibromatosis, Palmar fascial fibromatosis, Palmar fascia contracture, Viking disease, Dupuytren contracture

Last updated: December 18, 2024

Dupuytren contracture (Dupuytren disease) is a condition where the connective tissue beneath the skin of the palm slowly thickens and tightens. Firm nodules and thick cords can form from the palm into the fingers, and the skin may look thickened or pitted. Over years, these cords may pull one or more fingers into a bent position, most often the ring and small fingers, which can limit hand function.

Key Facts

  • •Dupuytren contracture is a condition in which the connective tissue (fascia) beneath the skin of the palm gradually thickens and tightens, forming cords that pull one or more fingers into a bent position
  • •Thickening or pitting of the skin in the palm
  • •Diagnosed through history, physical exam, and imaging
  • •First-line treatment includes exercise, weight management, and activity modification

What It Is

Dupuytren contracture is a condition in which the connective tissue (fascia) beneath the skin of the palm gradually thickens and tightens, forming cords that can pull one or more fingers into a bent position. The ring and small fingers are most commonly affected. The condition progresses slowly over years and can eventually limit hand function.

Affected Anatomy

This condition affects several structures in and around the joint:

  • •Palmar fascia (connective tissue beneath the palm skin)
  • •Pretendinous bands that extend toward the fingers
  • •Digital fascia of the affected fingers
  • •Most commonly affects the ring finger, followed by the small finger
  • •Multiple fingers may be involved in the same hand
  • •Both hands can be affected (often not symmetrically)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

  • •Thickening or pitting of the skin in the palm
  • •Formation of firm nodules in the palm
  • •Development of thick cords extending from the palm to fingers
  • •Gradual inability to fully straighten the affected fingers
  • •Fingers pulled into a bent (flexed) position toward the palm
  • •Difficulty placing the hand flat on a surface (positive tabletop test)
  • •Interference with activities like putting on gloves, shaking hands, or grasping objects
  • •Generally painless, though nodules may occasionally be tender

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

  • •Abnormal proliferation and contraction of myofibroblasts in the palmar fascia
  • •Strong genetic component with autosomal dominant inheritance pattern
  • •Exact cause of the abnormal tissue changes is not fully understood
  • •Environmental and lifestyle factors may influence progression

Risk Factors

  • •Family history of Dupuytren disease (strong genetic predisposition)
  • •Northern European ancestry
  • •Male sex (more common and often more severe in men)
  • •Age over 50 years
  • •Diabetes mellitus
  • •Smoking
  • •Alcohol consumption
  • •Epilepsy or use of certain anticonvulsant medications
  • •History of hand trauma or vibration exposure

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

  • •Medical history including family history and risk factors
  • •Physical examination of the hands and palms
  • •Palpation for nodules, cords, and skin changes
  • •Tabletop test: inability to place the palm flat on a surface
  • •Measurement of finger flexion contracture angles
  • •Imaging studies are generally not required for diagnosis
  • •Differentiation from other causes of finger contracture

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

  • •Observation for early or slowly progressing disease
  • •Needle aponeurotomy: using a needle to weaken or break the cord
  • •Dermofasciectomy: removal of fascia and overlying skin with skin grafting (for recurrent disease)
  • •Treatment is typically considered when contracture interferes with function

Physical Therapy and Exercise

  • •Stretching exercises and physical therapy (limited evidence of effectiveness)

Injections and Office-Based Procedures

  • •Collagenase injection (Xiaflex): enzyme injection to dissolve the cord followed by manipulation

Surgery

  • •Open fasciectomy: surgical removal of the diseased tissue

Prognosis and Recovery

The course of this condition varies between individuals:

  • •Dupuytren disease tends to progress slowly over many years
  • •Not all patients develop significant contractures requiring treatment
  • •Recurrence after treatment is common, especially in those with strong genetic predisposition
  • •Multiple treatments may be needed over a lifetime
  • •Treatment can improve hand function but does not eliminate the underlying condition

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Frequently Asked Questions

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