A guide to Dupuytren's contracture

Dupuytren's contracture is a relatively common condition that affects the hands, often interfering with daily activities like gripping or writing. While it progresses slowly and is usually painless, it can significantly impact quality of life if left untreated. A leading orthopaedic surgeon answers some common questions about Dupuytren's contracture, helping you recognise its signs, understand its causes, and explore treatment options.

What is Dupuytren's contracture?

Dupuytren's contracture is a condition that affects the hands, causing one or more fingers to bend towards the palm. This bending is due to a thickening and tightening of the fascia, a layer of tissue beneath the skin of the palm. While it isn’t typically painful, it can interfere with everyday tasks like gripping objects, shaking hands, or putting your hand in your pocket. The condition tends to develop slowly over months or years and often starts with small lumps or cords of tissue in the palm.

Who is at risk of developing it?

Dupuytren's contracture primarily affects older adults, typically those over the age of 50, and is more common in men than women. It has a strong genetic link, particularly among people of Northern European descent. This has led to its nickname, the “Viking disease.” Lifestyle factors like smoking, excessive alcohol consumption, and conditions such as diabetes are thought to increase the risk.

What are the early signs and symptoms?

The earliest sign of Dupuytren's contracture is usually a small, firm lump or nodule in the palm. Over time, these nodules may form thickened cords of tissue that pull one or more fingers towards the palm. The ring and little fingers are most commonly affected, although it can involve any finger. Initially, you may notice difficulty placing your hand flat on a surface or a reduced range of motion in the fingers.

What causes Dupuytren's contracture?

The exact cause of Dupuytren's contracture remains unclear, but it is believed to involve both genetic and environmental factors. It occurs due to abnormal collagen production in the fascia of the palm, leading to the formation of thickened bands of tissue. While genetics play a significant role, environmental triggers such as repeated hand trauma or exposure to certain chemicals may contribute to its development.

How is it diagnosed?

A diagnosis is usually straightforward and made by a doctor during a physical examination. Your doctor may ask you to perform simple movements, such as laying your hand flat on a table. Imaging tests, such as X-rays or ultrasounds, are rarely needed unless another condition is suspected.

What treatment options are available?

Treatment for Dupuytren's contracture depends on the severity of the condition. In mild cases, where function is not significantly impaired, observation may be all that is required. For more advanced cases, non-surgical treatments such as collagenase injections, which break down the thickened tissue, or needle aponeurotomy, which releases the contracted cords, may be recommended.

Surgery is an option for severe cases and involves removing the thickened tissue to restore movement. However, even after treatment, the condition can recur. Physical therapy is often recommended post-treatment to improve hand function and prevent stiffness.