What is Dupuytren’s Contracture?

Dupuytren’s contracture is a disorder of the palm of the hand and fingers. In the normal hand there is a fibrous tissue called fascia. Fascia covers the important nerves, blood vessels, muscles, and tendons. Fascia also stabilizes the skin. In Dupuytren’s disease, this fascia can become abnormal. It becomes thicker, forming cords. These cords are often mistaken for a tendon because they look and feel similar. Unlike a tendon that is moved by a muscle that shortens and lengthens, cord tissue is not connected to a muscle. Cord tissue is static and does not move. There may be a single cord or several. Cords can be separate or connected.

Most people with Dupuytren’s contracture will also have nodules or bumps in the hand. When they are first noticed, these nodules and cords may not change for a long time. They can also have a slow or fast change. Cords and nodules may become bigger and thicker over time. They may begin to pull the fingers into a bent (flexed) position so the fingers are bent toward the palm. This makes it impossible to fully open the fingers (Figures 1 and 2). This can become bothersome and limit use of the hand in many people.

Figure 1
Advanced case of Dupuytren’s Contracture with pits, nodules and cords leading to bending of the finger into the palm

Figure 2
Advanced case of Dupuytren’s Contracture with pits, nodules and cords leading to bending of the finger into the palm

Figure 3
Table top test for Dupuytren’s Contracture

Causes

The exact cause of Dupuytren’s contracture is unknown and very complex. It is a hereditary disease. This means family history and ancestry play a role. The problem is more common in men, people over age 40, and people of Northern European descent. It is less common in African and Middle Eastern descent. Smoking, diabetes, alcohol, lower body mass index, and aging are also all related to Dupuytren’s.

There is no evidence that hand injuries or specific jobs lead to a higher risk of developing Dupuytren’s contracture. There may be a mild relationship to trauma in someone who is at risk. Occasionally after a distal radius (wrist) fracture, a patient may develop a single nodule in the palm. This nodule may or may not be tender. It often does not progress to result in a bent finger joint.

Signs and Symptoms

Symptoms of Dupuytren’s contracture usually include lumps, nodules, and bands or cords on the palmar side of the hands. The lumps are generally firm and stuck to the skin of the palm. Skin can seem thicker and puckered. Think of the Dupuytren’s palm skin like a road. Some areas are swollen and puffy like a speed bump. In other areas the skin is puckered and pulled down like a pothole. Thick cords may develop from the palm into one or more fingers. These cords may cause bending of the fingers. The ring finger and little finger are most commonly involved. One or both hands can be affected. Each hand can be affected in a different pattern and at different times.

The lumps can be uncomfortable in some people. However; in most people, Dupuytren’s contracture is not typically painful. The disease may first be noticed due to difficulty in placing the hand flat on a surface (Figure 3) or opening the hand fully. It may be more difficult to wash hands, wear gloves, hold large objects, and get hands into pockets. When it involves the right hand, people can find it awkward to shake hands.

It is difficult to predict how the disease will progress. Some people have only small lumps or cords while others will develop severely bent fingers. There are a variety of risk factors. The disease tends to be more severe if it occurs at an earlier age. Men develop more severe symptoms when compared to women. If you have many relatives with the problem, you may be at higher risk for more severe disease. If there are changes in other areas of the body, you are at higher risk. This is called Dupuytren’s diathesis. Lumps and cords can develop on the soles of the feet (plantar fibromatosis) or the genital location in men (Peyronie’s disease). Occasionally, the disease will cause thickening on top of the knuckles called a knuckle pad (or Garrod’s pad).