Your Orthopaedic Connection: Dupuytren's Contracture

Dupuytren's Contracture

Dupuytren contracture of the ring finger.

Adapted with permission from the American Society for Surgery of the Hand: Brochure: Dupuytren's Disease. Englewood, CO 1995.

Dupuytren's contracture is an abnormal thickening of tough tissue (fibrous layer) underneath the skin of the palm and fingers. It is the thickening of this tissue that can cause the fingers to curl. Dupuytren's contracture is more common in men than in women.

Cause

The cause of Dupuytren's contracture is not known. It is not caused by an injury. It is not a cancer.

Dupuytren's contracture is most common in people of Northern European or Scandinavian ancestry
It often runs in families (hereditary).
It is associated with smoking and drinking.
It is associated with certain medical conditions, such as diabetes, thyroid problems, and seizures.
It is more common in older individuals.

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Symptoms

Signs of nodules and thickened bands of tissue on the palm and finger of a hand with Dupuytren's contracture.

Adapted with permission from the American Society for Surgery of the Hand: Brochure: Dupuytren's Disease. Englewood, CO 1995.

Dupuytren's contracture usually occurs very gradually. It may begin as one or more small tender lumps in the palm. Over time, the pain usually goes away. The nodules may thicken and contract. Tough bands of tissue may form that cause one or more fingers to bend toward the palm.

The ring and small fingers are most commonly affected. As the contractures increase, it may be difficult to use the affected fingers to grasp objects.

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Treatment

Nonsurgical Treatment

There is no way to stop or cure the problem. It is not dangerous. Dupuytren's contracture usually progresses very slowly and may not be troublesome for years. If a painful lump is present, an injection may help diminish the pain.

Surgical Treatment

Surgery is recommended when the inability to straighten the fingers significantly limits hand function. Surgery for Dupuytren's contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may sometimes be needed.

Risks of surgery include injury to nerves and blood vessels and infection. Some swelling and soreness are expected, but severe problems are rare. Elevating the hand after surgery and gently moving the fingers helps to minimize pain, swelling, and stiffness. A physical therapist may be helpful during recovery after surgery. Most people will have improved motion in the fingers after surgery. Surgery does not always cure the disease, which may progress gradually and sometimes recur over time.

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Research on the Horizon

Experiments are being performed with enzyme injections that may be able to break down the tough bands and improve motion without surgery. Early results are promising, but these injections are not available for general use at this time.

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Last reviewed and updated: October 2007

Co-developed with the American Society for Surgery of the Hand

AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.

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