What Is Dupuytren's Contracture?

Dupuytren's contracture (DC)—also called Dupuytren's disease—is a condition that causes an abnormal thickening of the fascia (the layer of tissue under the skin) in the palm at the base of the fingers. The thickened area will develop as either a hard lump or a thick band of skin. 

Over time, the skin's thickening might cause one or more fingers to contract, pull to the side, or bend toward the palm. The two fingers DC most commonly affects are the ring and pinky fingers. It often affects both hands. Though rare, it might also affect the feet. 

This article explains Dupuytren's contracture, including symptoms, causes, treatment, and more. 

Dupuytren's Contracture Symptoms

Worldwide prevalence for Dupuytren's contracture is around 4%, according to a 2019 Clinics in Dermatology report. DC is sometimes considered a systemic disease because it progresses over time. 

Some people with Dupuytren's might experience a mild condition with only soft tissue changes that do not limit function. Others will experience severe symptoms and actual contracture. 

Signs and symptoms of DC will appear in stages.

The earliest of those stages is the nodule phase. Nodules often appear over the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints.

Nodules will appear on the palms of the hands. The lumps may feel tender and sore initially, but the pain will subside. 

Some people might also experience pitting and dimpling of the skin near the nodule lumps. The skin will appear as if it has been pulled into the palm. 

Phase 2 is the cord stage, in which the nodules start to contract. Nodules cause rugged bands of tissue to develop. The tissue bands will be so inflexible they force the finger to bend or curl toward the wrist.

The next stage is the actual contracture phase, in which the curling and bending worsen, making it difficult to straighten out the fingers. You may struggle to pick up objects, retrieve small items, wear gloves, or even put your hands in your pockets.

Dupuytren's of the Foot 

Some people with DC might also develop Dupuytren's of the foot, sometimes called Ledderhose disease. It causes nodules on the soles of the feet. It will affect both feet and progress slowly. 

Dupuytren's of the foot has been linked to diabetes, alcohol use disorder, liver disease, epilepsy, and repeated foot trauma. It can cause pain and swelling of the feet and toes, trouble walking, and toe curling. 

DC of the foot causes you to change how you walk and puts pressure on other parts of the feet and the ankles. Forced changes to walking and your gait can lead to foot or ankle injuries or other foot and ankle troubles. 

Causes

The causes of DC are unknown, but the condition tends to run in families and is more common in people assigned male at birth.

Risk factors for DC include: 

• Age: The risk for DC increases with age. It tends to affect people in middle age, especially after age 50.
• Sex: Males have an increased risk for DC, and males tend to experience the condition before age 50. Females can develop the condition later in life but will have less severe disease. When citing research, Verywell Health uses the terms for sex and gender from the source.
• Family history: DC is believed to pass down through families and is its most common inherited condition. There are instances when DC occurs without a family history, but these cases are rare and less severe.
• Diabetes: Diabetes is a risk factor for DC, and according to one study, people with diabetes have a 3.06 times higher risk for DC.
• Smoking and alcohol: Both smoking and alcohol use are considered risk factors because they might affect the blood supply.
• Hand injuries: A hand injury might increase the risk for DC, but trauma is not a cause of the condition. One 2020 Medicina report found that one-fifth of people with DC had previously experienced trauma to their hand or wrist. That report also found that DC related to a prior hand or wrist injury was less progressive and affected people at younger ages.
  

Diagnosis

DC usually takes many years to develop, and some people experience a mild condition that never leads to contracture. Early diagnosis and treatment are crucial to avoiding a hand or foot deformity.

A diagnosis or DC starts with a review of your medical and family histories. The healthcare provider will ask you questions about symptoms and other health conditions you have. They will examine your wrists, hands, and fingers. If you have reported foot symptoms, they will also check your toes and soles.

During the physical exam of your hands and feet, the healthcare provider looks for nodules and areas of thickened skin. They will ask you to place your hands flat on a table to see if you have any trouble doing so or discomfort.

The healthcare provider will also want to see how well you grasp, pinch, and feel with your hands as well as your hand's range of motion. 

For DC of the feet, the healthcare provider will want to see how you walk and if you experience pain or have to adjust your walk because of nodules or pain. 

The healthcare provider might also take pictures of your hands and feet so they can record changes over time. 

They typically won't use X-rays or other imaging to diagnose DC because it is not an arthritis condition. The healthcare provider might take X-rays only if they suspect or want to rule out a bone or joint problem.

Ultrasound scans can offer answers about the severity and thickening of the skin but are not necessary for diagnosing the condition.

Treatment

There is no cure for DC, but treatment can help to resolve symptoms. For some, treatment isn't necessary, but they will need monitoring to see if the condition worsens. 

If the condition causes pain or affects your ability to perform daily activities, your healthcare provider will recommend non-surgical treatment. They might recommend surgery later on if the condition worsens or if a hand deformity is present.

Corticosteroid injections may work to slow down the progression of DC. These injections contain powerful anti-inflammatory medicines that can be injected into a nodule to reduce pain. 

Collagenase injections are newer, less invasive therapies for treating DC. Research shows these injections offer good results in the short and medium terms. An injection typically involves numbing the hand and injecting the enzyme into a nodule area. The enzyme will break down and dissolve the skin bands, allowing the fingers to straighten. 

Needle aponeurotomy is another option for treating DC. It is a procedure by which a surgeon numbs the hand and uses a needle to divide the problem tissue without making any incisions.

Radiotherapy has been encouraged as a treatment in early Dupuytren's disease, although it's not used frequently in the United States. Even so, the therapy is available, so if other therapies do not reduce progression, your healthcare provider might have more information. 

Splinting is not an option for reducing the progression of DC. According to the American Academy of Orthopaedic Surgeons (AAOS), forceful stretching of the contracted finger could lead to injury of the finger or hand. However, splinting might be used after surgery to protect the surgical site. 

Surgical Procedures

If DC affects the function of your hand, your healthcare provider might recommend surgery. The goal of surgery is to reduce the contracture and improve function.

The type of surgery for treating DC will depend on the extent of the contracture. Two standard surgical procedures for DC are fasciotomy and subtotal palmar fasciectomy.

Fasciotomy: With this procedure, a surgeon makes an incision at the palm. They will then divide the thickened cords of tissue. The procedure uses a local anesthetic, leaving the wound open to heal during recovery and then splinted.

Subtotal palmar fasciectomy: With this procedure, the surgeon will move as much of the abnormal tissue as possible to straighten out the fingers. The wound might be left open to heal, or, depending on how much of the hand was treated, a skin graft might be made, sealing it.

A splint will facilitate recovery. Because this procedure is more extensive than a fasciotomy, recovery might be painful and require more healing time and physical therapy. 

Prognosis

DC is a progressive condition and incurable condition, but the treatment of the condition can be successful. It is also unknown if the condition will progress. If it does, surgery can restore the hand's function and movement. 

Recurrence of contracture is possible even after surgery. Fortunately, most recurrences are less severe than initial cases and will not require extensive surgical intervention.

One study reported in 2017 in PLOS One defined recurrence as "more than 20 degrees of contracture recurrence in any treated joint at one-year post-treatment." They also suggest reporting recurrences separately for each affected joint and evaluating alternative treatments. 

Summary

Dupuytren's contracture is a condition in which fibrous tissue growth occurs in the palm, causing the layer of tissue under the skin to thicken. As the skin in the palm thickens, the fingers start to pull in or curl toward the middle part of the hand.

The condition causes nodules and cords to develop, eventually leading to the bending or curling of the fingers. Researchers do not know what causes DC, but they suspect possible risk factors, including genetics and family history, older age, being assigned male at birth, diabetes, alcohol consumption, and smoking. 

Treatment for DC usually starts with non-surgical treatments, such as injections, to keep the condition from progressing. Surgery is recommended when DC affects hand function and mobility.

Though surgery can restore hand function, it is possible to experience a recurrence even after surgery. Fortunately, recurrences are less severe than initial cases.