Dupuytren's Contracture
Dupuytren's contracture is a progressive fibrotic condition of the palm in which abnormal collagen builds up in the fascia—the connective tissue layer beneath the skin—forming thick cords that pull one or more fingers into a bent position. The ring and little fingers are most commonly affected. It tends to develop slowly over years, and many people do not notice it until a finger begins to resist straightening. The condition is more common in men, people of Northern European descent, and those with a family history; it is also associated with diabetes, smoking, and alcohol use.
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Symptoms
- Firm nodules or puckering of the palm skin, often painless at first
- Thickening of tissue along the palm toward the fingers
- One or more fingers gradually bending toward the palm and resisting straightening
- Difficulty laying the hand flat on a surface (the "tabletop test")
- Trouble with handshakes, glove-wearing, or reaching into pockets
- Usually painless, though some people have tenderness in early nodular stage
When to See a Doctor
See a hand surgeon when a finger contracture reaches 30 degrees or more, when you cannot lay your hand flat on a table, or when the contracture is interfering with daily tasks. Earlier treatment—before joint stiffness sets in—tends to produce better results.
Treatment Options
Observation
For nodules without contracture, or mild contractures that are not functionally limiting, careful monitoring is appropriate. There is no proven non-invasive treatment to halt early disease progression.
Needle aponeurotomy (percutaneous fasciotomy)
An office procedure in which a needle is used to divide the cord through the skin. Low downtime, quick recovery, but higher recurrence rates than surgery. Works best for cord-type (not nodular) disease.
Collagenase injection (Xiaflex)
An enzyme (clostridial collagenase) is injected into the cord; the next day the finger is manipulated to rupture it. Effective for single-cord disease. Similar recurrence rates to needle aponeurotomy.
Fasciectomy (surgical)
The diseased fascia is surgically removed. More complete than needle techniques; lower recurrence rates in the treated area. Performed under local or regional anesthesia with hand surgery expertise. Recovery involves hand therapy for several weeks.
Recovery Timeline
Needle aponeurotomy: back to light activities in days, hand therapy for 4–6 weeks. Collagenase: splinting and hand therapy for 4 months after the procedure. Surgical fasciectomy: 4–6 weeks of hand therapy, with full functional recovery in 2–4 months. Recurrence is common across all methods—most patients see some return of disease within 5–10 years.
Frequently Asked Questions
Is Dupuytren's contracture the same as trigger finger?
No. Trigger finger involves the tendon sheath, causing locking and clicking when the finger bends; it typically responds to steroid injection. Dupuytren's contracture involves the palmar fascia, causes a fixed contracture that cannot be fully straightened, and does not cause locking or triggering. Both are conditions a hand surgeon treats, but they require different treatments.
Can Dupuytren's contracture affect the thumb?
Yes, though it is less common than ring or little finger involvement. Thumb contracture can significantly affect pinch and grip strength. The same treatment options apply.
What type of doctor treats Dupuytren's contracture?
Hand surgeons—orthopaedic or plastic surgeons who specialize in hand surgery—treat Dupuytren's contracture. Look for a hand surgeon with experience in all three techniques (needle aponeurotomy, collagenase, and fasciectomy), as the best option depends on the individual pattern of disease.
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This information is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.