Dupuytren's Contracture: What It Is, What It Isn't, and When to Act | Form & Function MD
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Dupuytren's Contracture: What It Is, What It Isn’t, and When to Act

Form & Function MD · Dr. Ben, MD

Dr. Ben, MD · Orthopaedic Hand & Upper Extremity Surgeon

Patients with Dupuytren's contracture rarely come to me in pain. They come because something ordinary has become hard: laying a hand flat on a table, pulling on a glove, reaching into a pocket, shaking hands. A finger, usually the ring or small finger, has been slowly drawn toward the palm, and it won't come back.

What's actually happening

Just under the skin of the palm is a layer of tough connective tissue called the palmar fascia. In Dupuytren's disease, that tissue thickens. It starts as a firm nodule in the palm, often near the crease at the base of the ring finger. Over months to years, some nodules extend into cords that run into the finger. As a cord contracts, it pulls the finger into a bent position.

It's not a tendon problem. The tendons are usually normal. That's one of the most common misunderstandings, and it's why stretching and tendon exercises don't reverse it.

Trigger finger catches. Dupuytren's pulls. They can look similar for a moment, but they're entirely different problems.

Who gets it

Dupuytren's runs strongly in families and is more common in men, in people of Northern European ancestry, and with increasing age. It's also associated with diabetes, smoking, and heavy alcohol use. Some people develop thickened pads over the knuckles or nodules in the arch of the foot, which belong to the same family of conditions.

Surgeons sometimes talk about a "Dupuytren's diathesis": an aggressive pattern marked by onset at a young age, both hands affected, a strong family history, and disease outside the palm. People with these features tend to progress faster and recur more often after treatment.

Trigger finger vs. Dupuytren's
  • Trigger finger: catching, clicking, or locking as the finger moves; often painful; the finger can usually be straightened.
  • Dupuytren's: a fixed bend that steadily worsens; usually painless; a palpable cord or nodule in the palm; the finger can't be pushed straight.
  • The two can exist in the same hand, which is part of why an exam matters.

The tabletop test

Place your hand palm-down on a flat table. If your palm and fingers can lie flat, treatment generally isn't needed yet. If they can't, the contracture has reached the point where it's worth a conversation with a hand surgeon.

Nodules alone, without a contracture, are usually just watched. Treating a nodule early doesn't stop the disease from progressing. Some nodules stay unchanged for decades; others progress within a couple of years. There's no way to predict which with certainty, so the practical approach is to monitor and act when function is affected.

Why the middle knuckle matters most

Contracture at the knuckle where the finger meets the hand (the MCP joint) usually corrects well after treatment, even when it's significant. Contracture at the middle knuckle (the PIP joint) is less forgiving. When that joint has been held bent for a long time, the joint itself and its surrounding structures stiffen, and full straightening may not come back even after the cord is released.

That's why, when I examine a hand with Dupuytren's, the PIP joint gets my closest attention, and it's often the joint that determines when I recommend acting.

Treatment options

The main options once a finger contracts
  • Needle release (percutaneous needle aponeurotomy): done in the office under local anesthesia. A needle is used to weaken and break the cord. Recovery is fast, but recurrence is more common than after surgery.
  • Enzyme injection: where available, an enzyme is injected into the cord to weaken it, and the finger is straightened a day or so later. Quick recovery; recurrence rates fall between needle release and surgery.
  • Surgery (fasciectomy): the diseased tissue is removed through an incision. It's the most durable option, with a longer recovery that typically includes hand therapy and a night splint.
  • Splinting and stretching alone do not correct an established contracture.

The right choice depends on which joints are involved, how severe the contracture is, how quickly someone needs to be back to work or sport, and how aggressive their disease appears.

Recurrence is part of the disease, not a failure of the treatment. The biology is still there after the cord is gone.
When to see a hand surgeon
If your hand can no longer lie flat on a table, if the middle knuckle of a finger is starting to bend, or if the contracture is interfering with daily tasks, it's time for an evaluation. Earlier treatment of a PIP contracture generally gives a better chance of full straightening.

This article is for education, not a diagnosis. If something here sounds like you, see a physician who can examine you.

  1. Black EM, Blazar PE. Dupuytren disease: an evolving understanding of an age-old disease. J Am Acad Orthop Surg. 2011;19(12):746–757.
  2. Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytren's diathesis revisited: evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg Am. 2006;31(10):1626–1634.
  3. Hurst LC, et al. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009;361(10):968–979.