Dupuytren's contracture explained

What Dupuytren's contracture is

Just beneath the skin of the palm lies a thin sheet of tissue called the palmar fascia, which normally helps you grip. In Dupuytren's contracture, this tissue slowly thickens and forms firm lumps, called nodules, and tough bands, known as cords, that run under the skin of the palm and fingers. Over time these cords can shorten and tighten, pulling the affected fingers inwards towards the palm so they gradually bend and cannot be fully straightened. This bending is the contracture. It most often affects the ring and little fingers and can involve one or both hands. The process is usually slow and painless, developing over months to years. It is not a cancer and is not caused by injury in most people, but rather by a change in the way this particular tissue behaves.

The symptoms it causes

The first sign is often one or more small, firm lumps in the palm, usually near the base of the ring or little finger, which may feel tender at first but are generally painless. The overlying skin can become puckered or dimpled. Over time, thickened cords may develop and extend from the palm into the fingers. As these tighten, the affected finger is slowly drawn towards the palm and becomes harder to straighten fully. This can make everyday tasks awkward, such as putting on gloves, shaking hands, washing the face or putting the hand flat in a pocket. The condition usually progresses slowly and unpredictably, sometimes staying the same for long periods. It does not usually cause pain in its later stages, and it does not affect the ability to bend the fingers, only the ability to straighten them.

What causes it and who gets it

The exact cause of Dupuytren's contracture is not fully understood, but it involves an abnormal change in the palm tissue and is strongly influenced by inherited factors, so it often runs in families. It is more common in men than women, becomes more frequent with age, and is particularly associated with people of Northern European descent, which is why it has sometimes been called Viking disease. Several factors are linked to a higher chance of developing it or of it being more severe, including a family history, smoking, drinking a lot of alcohol, diabetes, and possibly some seizure conditions or their treatment. Heavy manual work and hand injury have been suggested as contributors in some people, but for most it is not caused by using or injuring the hands. Understanding these links can help explain why it develops, though often it appears without an obvious reason.

How it is diagnosed and managed

Dupuytren's contracture is almost always diagnosed simply by examining the hand, as the firm nodules and cords in the palm and the bending of the fingers are characteristic; tests and scans are rarely needed. A useful check is the tabletop test — if you cannot lay your hand flat on a table because a finger stays bent, treatment may be worth considering. Not everyone needs treatment: if the condition is mild and does not interfere with hand function, it can simply be watched. When a contracture is limiting the use of the hand, treatments aim to straighten the finger by dividing or removing the tightened cord. Options include surgery to remove the diseased tissue, a less invasive technique using a needle to divide the cord, and, in some cases, injections. The choice depends on the severity, which fingers are affected and individual circumstances, and is discussed with a hand specialist.

Living with Dupuytren's contracture

For many people, Dupuytren's contracture is a slow, mild condition that never seriously affects the hand and simply needs occasional review. It can help to keep an eye on progress using the tabletop test and to seek advice if a finger becomes noticeably harder to straighten or hand function is affected. Where lifestyle factors such as smoking or heavy alcohol use are involved, addressing these is good for general health, and managing conditions like diabetes is worthwhile. It is important to know that treatment can improve a bent finger but does not cure the underlying tendency, so the condition can come back over time and may need further treatment. After a procedure, hand therapy and exercises help maintain movement. Discussing the timing and type of any treatment with a hand specialist ensures it fits your needs and expectations, and most people continue to use their hands well.