Carl R. Darnall Army Medical Center - Health Library

Dupuytren Contracture

Pronounced: du-pwe-trahn kon-trak-choor

Definition

Dupuytren contracture is a thickening of tissue in the palm of the hand. It causes one or more fingers to be curled in toward the palm. The contracture can make it difficult or impossible to straighten these fingers.

Dupuytren Contracture Scarring
Nucleus factsheet image

Copyright © Nucleus Medical Media, Inc.

Causes  ^

The exact cause is not known. Some may inherit the trait from a parent.

Risk Factors  ^

This condition is more common in:

  • Men
  • People over 40 years of age

Factors that may increase your chances of getting Dupuytren contracture include:

  • A parent with Dupuytren contracture
  • Hand trauma
  • Manual labor
  • Vibration exposure at work
  • Alcohol use disorder
  • Epilepsy
  • Use of certain anticonvulsant medications for epilepsy
  • Liver disease
  • Smoking
  • Diabetes

Symptoms  ^

Dupuytren contracture can happen on either one or both hands. The first sign is a nodule (bump) in the palm near the bottom of a finger. It may be sensitive to touch. However, this condition is often not painful.

The bump then becomes a thickened cord. As the cord thickens, it shortens and pulls on the fingers. This curls the affected finger toward the palm. At first, the curling of the fingers are mild. It may worsen over time. How fast it worsens can differ from person to person.

The ring finger is usually affected first. The pinky finger is often second. The index, and long finger may follow. Movement in the fingers will become more difficult over time.

Diagnosis  ^

You will be asked about your symptoms and medical history. A hand exam will be done. The doctor will often be done based on exam.

Treatment is more effective when the contracture is found early.

Treatment  ^

Treatment will help you regain use of your fingers. You may not need treatment yet if you still have normal use of your hand. Once it has progressed treatment options include:

Surgery

Surgery is most effective in the early stages. Surgery may involve:

  • Making small incisions in the thickened tissue
  • Removing diseased tissue
  • Removing diseased tissue and overlying damaged skin
    • Skin grafts may be needed for gaps
  • Percutaneous needle fasciotomy—can release tissue without large incisions

All surgeries have some risk of bleeding and infection. Dupuytren contracture can also come back after surgery.

Exercise Therapy After Surgery

Exercise therapy may be needed. It can help to restore full range of motion after a repair.

Injected Medication

Medication may be injected into the area. Options include:

  • Corticosteroids—during early stages may
    • Slow the worsening of the condition
    • Ease any tenderness
  • Collagenase clostridium histolyticum—breaks down the thickened tissue in the hand

Prevention  ^

There is nothing that has been shown to prevent Dupuytren contracture.

RESOURCES:

American Society for Surgery of the Hand
http://www.assh.org

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

Canadian Centre for Occupational Health and Safety
http://www.ccohs.ca

Health Canada
https://www.canada.ca/en/health-canada.html

REFERENCES:

Badalamente MA, Hurst LC, Benhaim P, Cohen BM. Efficacy and safety of collagenase Clostridium Histolyticum in the treatment of proximal interphalangeal joints in Dupuytren contracture: Combined analysis of 4 phase 3 clinical trials. J Hand Surg. 2015;5:975-983.

Degreef I, Tejpar S, Sciot R, De Smet L. High-dosage Tamoxifen as neo adjuvant treatment in minimally invasive surgery for Dupuytren Disease in patients with strong pre disposition toward fibrosis. J Bone Joint Surg Am. 2014;96(8):655-662.

Dupuytren disease. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease. Updated February 8, 2017. Accessed September 7, 2017.

Lanting R, Broekstra DC, Werker PMN, van den Heuvel ER. A systematic review and meta-analysis on the prevalence of Dupuytren Disease in the general population of Western countries. Plast Reconstr Surg. 2014;133(3):593-603.

Rahr L, et al. Percutaneous needle fasciotomy for primary Dupuytren's contracture. J Hand Surg Eur Vol. 2011;36(7):548-552.

Riester S, vanWijnen A, Rizzo M, Kakar S. Pathogenesis and treatment of Dupuytren disease. J Bone Joint Surg Reviews. 2014;2(4):e2.

van Rijssen AL, et al. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg. 2012 Feb;129(2):469-77.

2/12/2010 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T114104/Dupuytren-disease: FDA approves Xiaflex for debilitating hand condition. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199736.htm. Published February 2, 2010. Accessed September 23, 2014.

Last reviewed January 2018 by EBSCO Medical Review BoardTeresa Briedwell, PT, DPT, OCS, CSCS  Last Updated: 6/14/2018