Dupuytren's contracture begins as a thickening in the palm — a firm cord or nodule that forms in the fascia beneath the skin, most often at the base of the ring or little finger. In its early stages it is painless, not particularly alarming, and easy to dismiss as a callus or benign thickening. Over months to years, that cord contracts and draws the affected finger into a flexed position that cannot be passively straightened. At that point, function is meaningfully limited — gripping a steering wheel, shaking hands, putting on a glove, placing the hand flat on a table — and the treatment is more involved than it would have been earlier.
The genetic component is striking and worth knowing. Dupuytren's is strongly associated with Northern European ancestry — sometimes called Viking disease, with prevalence rates as high as 30 percent in Scandinavian populations. Men are affected at a significantly higher rate than women and tend to have more progressive disease. Other predisposing factors include diabetes, heavy alcohol use, smoking, and certain seizure medications. If a parent or sibling has Dupuytren's, your own palms are worth a periodic look.
- Firm nodule or thickening in the palm, painless, fingers straighten fully
- No contracture — the finger lies flat when the hand is placed on a table
- Condition stable and unchanged over the past six to twelve months
- No functional limitations in daily activities or grip
- Finger cannot be fully straightened — a measurable contracture angle is developing
- Unable to place the affected hand flat on a table surface
- Contracture progressing noticeably over a period of months
- Functional limitations in grip, gloves, or daily tasks
- Contracture greater than 30 degrees at the MCP joint or any contracture at the PIP joint
"Treatment is most straightforward when contractures are moderate and the joint itself has not been structurally altered by prolonged flexion. Waiting for the finger to be completely bent down does not make the case simpler."
Treatment options have expanded
Treatment options have expanded meaningfully in the past decade. Needle aponeurotomy — a minimally invasive office procedure using a needle to disrupt the cord — and collagenase injection, which dissolves the cord enzymatically, both offer effective alternatives to open surgical fasciectomy for appropriate cases. The right treatment depends on the pattern and severity of the contracture, and that decision is worth making with a hand surgeon who performs all three.
Questions about Dupuytren's or palm lumps?
Ask on Instagram →- Rayan GM. Dupuytren disease: anatomy, pathology, presentation, and treatment. Journal of Bone and Joint Surgery. 2007;89(1):189–198. doi:10.2106/JBJS.F.00584
- Hurst LC, Badalamente MA, Hentz VR, et al. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. New England Journal of Medicine. 2009;361(10):968–979. doi:10.1056/NEJMoa0810866
- van Rijssen AL, ter Linden H, Werker PM. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plastic and Reconstructive Surgery. 2012;129(2):469–477. doi:10.1097/PRS.0b013e31823aebb1